| BackgroundFetal ventriculomegaly is one of the most common fetal malformations and its incidence is l~2%o. It endangers the life of fetus and influences infant mental development. Thus, it is important to diagnose fetal ventriculomegaly prenatally.Ventriculomegaly is diagnosed when unilateral or bilateral width of ventricle is more than 10 mm. When the width is more than 15mm, it is considered severe ventriculomegaly, While between 10mm and 15mm it is considered as mild ventriculomegaly. It is widely accepted that the prognosis of severe ventriculomegaly is poor. However, it has been disputed whether mild ventriculomegaly is predictive of poor prognosis. Some investigators think that mild ventriculomegaly is basically of good prognosis, but is at an increased risk of retarded neurological development and chromosomal aberrations, while others think that it is a prenatal manifestation of central nervous system disorders and that its prognosis is hard to be predicted.Mild ventriculomegaly can be classified into to two types according to the presence or absence of other abnormalities. One type is the one combined with other abnormalities and it is closely associated with chromosomal aberrations. The other type is the isolated ventriculomegaly. Up to date, there were no many investigationsabout isolated mild ventriculomegaly. Following are some of the problems that need to be explored: (1) In the previous studies, the width of ventricle is measured at posterior horn while the anterior horn of ventricle has not been focused on. (2) most of the studies available did not distinguish isolated ventriculomegaly from that complicated with other abnormalities, although there is evidence that the prognosis of isolated mild ventriculomegaly is probably better than that of complicated mild ventriculomegaly (3) The previous studies paid much attention to the relation between mild ventriculomegaly and either chromosomal aberrations or the disease of living infants, but little attention was paid to the neurodevelopment outcome of mild ventriculomegaly after birthThus, the purpose of the current study was to improve the ultrasound measurement of ventricle and to evaluate the neurodevelopment outcome of the fetus with isolated mild ventriculomegaly.Improvement of ultrasound measurement of ventricleThe widths of anterior horn of ventricle measured prenatally and postnatally are not always closely related because different planes were used to measure the width of anterior horn in fetus and infants. So in our primary study, we tried to improve the ultrasound measurement of anterior horn of ventricle. We measured anterior horn of fetal lateral ventricle at the oblique plane and compared the width with that obtained by previously used method (at coronal plane). In the investigation of 60 cases, we found that the new method is superior to the previously used method regarding both sensitivity and specificity and that there is no significant difference between the values that was measured by the new method antenatally and in coronal plane postnatally. So, we used the improved measurement in the study.Materials and Methods34 cases, whose width of posterior horn is between 10 mm and 15mm or width ofanterior horn is more than 3mm, either unilateral or bilateral, were enrolled into the study group. All the fetuses in the study group do not have any other malformations. At the same time, 15 normal fetuses were taken as control 1 group, and 15 cases with cistern magna between 10 mm and 15mm as control 2. All the participants received routine ultrasonic scan at Women's Hospital, School of Medicine, Zhejiang University during September 2001 and October 2003 and were followed up by ultrasonic exam during the pregnancy, the 3rd day and the 6th month after birth. Resistance index of fetal middle cerebral artery (MCA) were measured. Neonatal Behavioral Neurological Assessment (NABA) score was evaluated at the 2nd and the 7th day after birth. And intelligence age was evaluated at the 6l month after birth. All the data we... |
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