Early-onset versus late-onset fetal cerebral ventriculomegaly: Sonographic characteristics and neonatal outcomes

Abstract

Objectives: This study aimed to compare the prenatal ultrasound characteristics, pregnancy outcomes, and neonatal prognosis of early- and late-onset fetal ventriculomegaly (VM).

Methods: A retrospective analysis was conducted on 102 pregnant women diagnosed with fetal VM, categorized into early-onset (≤24 weeks) and late-onset (>24 weeks) groups. Maternal characteristics, ventricular dimensions, associated anomalies, pregnancy outcomes, and neonatal parameters were compared between the groups.

Results: Early-onset VM was significantly associated with progressive ventricular enlargement, bilateral involvement, and a higher prevalence of additional anomalies detected via ultrasonography (70.4% vs. 29.2%, P<0.001) and Magnetic resonance imaging (MRI) (35.4% vs. 16.7%, P=0.030). Prenatal ultrasound findings differed significantly between the groups; early-onset VM cases more frequently exhibited bilateral (72.2% vs. 39.6%, P=0.002) and asymmetric (46.3% vs. 31.2%, P=0.037) ventricular enlargement, while late-onset VM was more commonly isolated (70.8% vs. 29.6%, P<0.001) and unilateral (60.4% vs. 27.8%). Live birth rates were lower (55.6% vs. 85.4%, P=0.001), pregnancy termination rates were higher (44.4% vs. 14.6%, P=0.001) and chromosomal abnormalities were higher (16.7% vs. 8.3%, P=0.246) in early-onset cases. Additionally, Apgar scores at 1 and 5 minutes were significantly lower in the early-onset group (P=0.028 and P=0.042, respectively).

Conclusions: Early-onset VM is more frequently associated with ventricular progression and structural anomalies, leading to poorer pregnancy and neonatal outcomes. These findings highlight the importance of close prenatal monitoring, including detailed ultrasound, fetal MRI, and genetic evaluation, to guide clinical management and parental counseling. Future studies with long-term neurodevelopmental follow-up are needed to further refine risk stratification and optimize patient care.

Keywords

• Fetal cerebral ventriculomegaly
• prenatal ultrasound
• fetal MRI
• pregnancy outcome
• congenital anomalies
• isolated ventriculomegaly

References

1. 1. Society for Maternal-Fetal Medicine (SMFM); Fox NS, Monteagudo A, Kuller JA, Craigo S, Norton ME. Mild fetal ventriculomegaly: diagnosis, evaluation, and management. Am J Obstet Gynecol. 2018;219(1):B2-B9. doi: 10.1016/j.ajog.2018.04.039.
2. 2. Bhatia A, Thia EWH, Bhatia A, Ruochen D, Yeo GSH. Sonographic spectrum and postnatal outcomes of early-onset versus late-onset fetal cerebral ventriculomegaly. J Matern Fetal Neonatal Med. 2022;35(23):4612-4619. doi: 10.1080/14767058.2020.1857358.
3. 3. Giorgione V, Haratz KK, Constantini S, Birnbaum R, Malinger G. Fetal cerebral ventriculomegaly: What do we tell the prospective parents? Prenat Diagn. 2022;42(13):1674-1681. doi: 10.1002/pd.6266.
4. 4. Wang X, Zhang S, Wang J, Zhang S, Feng L, Wu Q. Follow-up outcome analysis of 324 cases of early-onset and late-onset mild fetal ventriculomegaly: a retrospective cohort study. Eur J Med Res. 2024;29(1):128. doi: 10.1186/s40001-024-01709-7.
5. 5. Rosseau GL, McCullough DC, Joseph AL. Current prognosis in fetal ventriculomegaly. J Neurosurg. 1992;77(4):551-555. doi: 10.3171/jns.1992.77.4.0551.
6. 6. Winkler A, Tölle S, Natalucci G, Plecko B, Wisser J. Prognostic Features and Long-Term Outcome in Patients with Isolated Fetal Ventriculomegaly. Fetal Diagn Ther. 2018;44(3):210-220. doi: 10.1159/000480500.
7. 7. Pappas A, Adams-Chapman I, Shankaran S, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage. JAMA Pediatr. 2018;172(1):32-42. doi: 10.1001/jamapediatrics.2017.3545.
8. 8. Horgos B, Mecea M, Boer A, et al. White matter changes in fetal brains with ventriculomegaly. Front Neuroanat. 2023;17:1160742. doi: 10.3389/fnana.2023.1160742.

9. 9. Kyriakopoulou V, Vatansever D, Elkommos S, et al. Cortical overgrowth in fetuses with isolated ventriculomegaly. Cereb Cortex. 2014;24(8):2141-2150. doi: 10.1093/cercor/bht062.
10. 10. Di Mascio D, Sileo FG, Khalil A, et al. Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019;54(2):164-171. doi: 10.1002/uog.20197.
11. 11. Carta S, Kaelin Agten A, Belcaro C, Bhide A. Outcome of fetuses with prenatal diagnosis of isolated severe bilateral ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;52(2):165-173. doi: 10.1002/uog.19038.
12. 12. Ali F, Gurung F, Nanda S, et al. Perinatal and neurodevelopmental outcomes of fetal isolated ventriculomegaly: a systematic review and meta-analysis. Transl Pediatr. 2024;13(4):555-574. doi: 10.21037/tp-23-548.
13. 13. Zhao D, Cai A, Wang B, Lu X, Meng L. Presence of chromosomal abnormalities in fetuses with isolated ventriculomegaly on prenatal ultrasound in China. Mol Genet Genomic Med. 2018;6(6):1015-1020. doi: 10.1002/mgg3.477.
14. 14. Huang RN, Chen JY, Pan H, Liu QQ. Correlation between mild fetal ventriculomegaly, chromosomal abnormalities, and copy number variations. J Matern Fetal Neonatal Med. 2022;35(24):4788-4796. doi: 10.1080/14767058.2020.1863941.
15. 15. Chu N, Zhang Y, Yan Y, Ren Y, Wang L, Zhang B. Fetal ventriculomegaly: Pregnancy outcomes and follow-ups in ten years. Biosci Trends. 2016;10(2):125-132. doi: 10.5582/bst.2016.01046.
16. 16. Hudgins RJ, Edwards MS, Goldstein R, et al. Natural history of fetal ventriculomegaly. Pediatrics. 1988;82(5):692-697.
17. 17. Chervenak FA, Duncan C, Ment LR, et al. Outcome of fetal ventriculomegaly. Lancet. 1984;2(8396):179-181. doi: 10.1016/s0140-6736(84)90477-x.
18. 18. Vintzileos AM, Campbell WA, Weinbaum PJ, Nochimson DJ. Perinatal management and outcome of fetal ventriculomegaly. Obstet Gynecol. 1987;69(1):5-11.