Browsing by Author "Pretorius, Cornelius Hermanus Zacharias"

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    The context of fetal ventriculomegaly in a developing country : a retrospective review
    (2019-12) Pretorius, Cornelius Hermanus Zacharias; Van der Merwe, J. L.; Geerts, L. T. M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    AIM: The goal of this study is to describe fetal ventriculomegaly (VM) in a developing country population with regards to clinical presentation, associated findings, natural history and outcome. Materials and methods This retrospective observational study was conducted at Tygerberg Academic Hospital, a secondary and tertiary referral centre in the Western Cape Province. Data was collected from all pregnancies with a prenatal diagnosis of ventriculomegaly from 2013 to 2015. The initial presentation and associated findings with the natural history of VM was studied and a selection of perinatal outcomes was measured. Results A final cohort of 252 cases was analysed: 168 mild, 42 moderate and 42 severe cases of VM. The median gestational age at diagnosis was 23w4d, with 48,8% diagnosed after 24w0d. Mild VM was more likely to be unilateral (p<0,001) and isolated (p=0,006) when compared to moderate and severe VM. Mild VM was associated with multiple soft markers in up to a third of the cases and over half of the cases normalized during pregnancy; severe VM was associated with multiple major anomalies in 31,0% of the cases. The majority of major anomalies in all 3 groups were CNS defects in 25,8% and cardiac anomalies in 10,3%. Termination of pregnancy was opted for in 12,5% of mild, 35,7% of moderate and 59,5% of severe VM cases. Conclusion VM is a common prenatal finding but, in this setting, was often diagnosed late, which limits options for investigation and management. Associated findings included cardiac and other CNS abnormalities and increased with increasing severity of VM. Aneuploidies were encountered within all groups. In this cohort, unilateral VM was more associated with mild VM and may have been due to the inclusion of borderline VM, which was shown not to be a benign finding. Uptake of invasive testing and of TOP was low in this community and the late diagnosis may have contributed to that.