Mild Cerebral Ventriculomegaly on Prenatal Ultrasound – Next Steps and Clinical Implications
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Define mild ventriculomegaly 2. Describe the management of a pregnancy when mild ventriculomegay is identified
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
According to SMFM recommendations, mild cerebral ventriculomegaly is identified on a prenatal ultrasound report when the atrium measures between 10-12 mm. Next steps include
Detailed anatomical study
Refer for genetic counseling
Consider diagnostic testing for aneuploidy
ACOG/SMFM guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
Consider maternal toxoplasmosis and cytomegalovirus (CMV) testing regardless of whether the patient is aware of previous exposure
Consider fetal MRI for detection of associated cortical anomalies or signs of cerebral infection
May be of less value if a patient has already had an ultrasound examination by a professional with expertise in fetal brain imaging on ultrasound
Deliver based on standard clinical indications
If no abnormal findings detected on thorough examination, prognosis is favorable and the newborn is expected to be normal
Repeat ultrasound in the 3rd trimester, (30-34 weeks gestation)
Prognosis is better if measurement remains stable or improves/resolves
Serial ultrasounds unlikely to be helpful
Antepartum fetal testing not likely to be beneficial
Antiplatelet antibodies if intracranial hemorrhage also present
Mild/moderate ventriculomegaly may be seen in approximately 1% of fetuses. While mild cerebral ventriculomegaly may resolve or be of no consequence, clinical work-up is required to determine whether there is any physical obstruction, decreased cerebral volume or conditions that may alter production, reabsorption or cerebral spinal fluid (CSF) flow within the cerebral ventricles. Measurements of the lateral cerebral ventricles are obtained from an axial plane at the level of the thalamic nuclei.
‘Fetal cerebral ventriculomegaly’ is present if the atrial diameter is ≥10mm and the SMFM further refines this definition as follows
Mild: 10-12 mm
Moderate: 13-15 mm
Severe: >15 mm
Ventriculomegaly is found in 0.15%-0.7% of chromosomally normal/euploid fetuses
When isolated, the incidence of an abnormal karyotype is 3.8% although some centers report higher rates
If patient opts for invasive testing, microarray is critical as copy number variants (CNVs) have been found in 8.3% of isolated cases following normal karyotype and were highly correlated with neurodevelopmental disorders
Ventriculomegaly is also associated with genetic syndromes, brain malformations, feto-neonatal alloimmune thrombocytopenia and congenital infections
Often, no cause will be found
Postnatal follow-up by pediatric neurologists and specialists should be considered
While children with a prenatal diagnosis of mild ventriculomegaly will overall have a very good prognosis, a few may still have abnormal neurodevelopment, dependent on associated anomalies and etiology
When only one ventricle is mildly enlarged and there are no other findings, chromosomal work up is more likely to be normal
There is still a risk of congenital infections (8.2%) and additional brain abnormalities (5% prenatal and 6.4% postnatal), as well as a risk of neurodevelopmental delay of 5.9%
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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