# The Evaluation of Risk Factors and Results in Pregnant Women with Intrauterine Fetal Hydrocephalus: A Single Center Experience

## Authors

- Nazli Korkmaz ([ORCID](https://orcid.org/0000-0003-2166-8344)) — Department of Obstetrics and Gynecology, Demiroglu Bilim University, Istanbul, Turkey
- Ibrahim Alatas ([ORCID](https://orcid.org/0000-0001-5371-4638)) — Department of Neurosurgery, Baskent University-Istanbul Hospital, Istanbul, Turkey
- Nejdet Oncu ([ORCID](https://orcid.org/0000-0003-2166-8344)) — Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Research Center, Istanbul, Turkey
- Ali Ekiz ([ORCID](https://orcid.org/0000-0003-1102-6436)) — Department of Obstetrics and Gynecology, Atakoy Towers Private Clinic, Istanbul, Turkey
- Alev Atis Aydin ([ORCID](https://orcid.org/0000-0001-9999-3273)) — Department of Obstetrics and Gynecology, Sarıyer Hamidiye Etfal Training & Research Hospital, Istanbul, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 8, Issue 1 (2022), pages 58–63
- **Article type:** Original Article
- **Published online:** 2022-03-09
- **DOI:** [10.5455/umj.20211122060917](https://doi.org/10.5455/umj.20211122060917)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=18828
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/18828.pdf

## Abstract

Introduction Fetal hydrocephalus (FHC) occurs as a result of excessive production of cerebrospinal fluid (CSF) or CSF absorption or circulation disorders.We aim to evaluate risk factors, and to analyze the management and results in pregnant women diagnosed with FHC. Material and Methods Pregnant women diagnosed with prenatal FHC in the perinatology center between January 2015-December 2020 were included in the study, retrospectively. Demographic datas and anomalies accompanying FHC were analyzed. The frequency of fetal magnetic resonance imaging(MRI), amniocentesis and/or karyotype analysis rates, and termination frequency were examined. Results A total of 117 patients with intrauterine FHC were included. The median age and gestational week were 25.5 years and 21+4 weeks. Isolated FHC was observed in 32.5%. The frequency of fetal USG use is 97.4%; MRI was performed only in 3 (2.6%) patients. The amniocentesis and karyotype analysis were performed in 17.1% and 15.4%. While the presence of isolated FHC or accompanying anomalies has no effect on performing amniocentesis and karyotype analysis; it was determined that karyotype analysis was applied significantly less in case of NTD diagnosis(p=0.001). While the termination rates was 47.9; live birth occurred in 51.3%. The gestational week was significantly lower in patients who were terminated than in those whose delivery was decided (median 20+3 vs 23+2) (p=0.015). Termination rates were found to be significantly lower than those with anomaly accompanying FHC(p=0.018). Conclusion Accuracy rates of fetal USG in the diagnosis of prenatal FHC are quite high. Prenatal diagnosis and timing are important factors affecting termination and live birth rates.

## Keywords

fetal hydrocephalus; prenatal diagnosis; pregnancy; neural tube defect; amniocentesis

## How to cite

Korkmaz N, Alatas I, Oncu N, Ekiz A, Aydin AA. The Evaluation of Risk Factors and Results in Pregnant Women with Intrauterine Fetal Hydrocephalus: A Single Center Experience. Ulutas Med J. 2022;8(1):58-63. doi:10.5455/umj.20211122060917

## References

1. Wang R, Ding Y, Yang M, Lai W. Diagnosis, management, and neurodevelopmental outcomes of fetal hydrocephalus: an observational prospective study. Childs Nerv Syst. 2021 https://doi.org/10.1007/s00381-021-05213-9
2. Pilu G, Falco P, Gabrielli S, Perolo A, Sandri F, Bovicelli L. The clinical significance of fetal isolated cerebral borderline ventriculomegaly: report of 31 cases and review of the literature. Ultrasound Obstet Gynecol. 1999;14(5):320-6 https://doi.org/10.1046/j.1469-0705.1999.14050320.x
3. Pisapia JM, Sinha S, Zarnow DM, Johnson MP, Heuer GG. Fetal ventriculomegaly: Diagnosis, treatment, and future directions. Childs Nerv Syst. 2017;33(7):1113-1123 https://doi.org/10.1007/s00381-017-3441-y
4. Peiro JL, Fabbro MD. Fetal therapy for congenital hydro cephalus-where we came from and where we are going. Childs Nerv Syst. 2020;36(8):1697-1712 https://doi.org/10.1007/s00381-020-04738-9
5. Cavalheiro S, Moron AF, Almodin CG, Suriano IC, Hisaba V, Dastoli P, Barbosa MM. Fetal hydrocephalus. Childs Nerv Syst. 2011;27(10):1575-83 63 77 Intrauterine Fetal Hydrocephalus Korkmaz et al.
6. Karimy JK, Reeves BC, Damisah E, Duy PQ, Antwi P, David W, Wang K, Schiff SJ, Limbrick DD Jr, Alper SL, Warf BC, Nedergaard M, Simard JM, Kahle KT. Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol. 2020;16(5):285-296 https://doi.org/10.1038/s41582-020-0321-y
7. Tugcu AU, Gulumser C, Ecevit A, Abbasoglu A, Uysal NS, Kupana ES, Yanik FF, Tarcan A. Prenatal evaluation and postnatal early outcomes of fetal ventriculomegaly. Eur J Paediatr Neurol. 2014;18(6):736-40 https://doi.org/10.1016/j.ejpn.2014.07.002
8. Di Mascio D, Sileo FG, Khalil A, Rizzo G, Persico N, Brunelli R, Giancotti A, Panici PB, Acharya G, D'Antonio F. 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 https://doi.org/10.1002/uog.20197
9. Nomura ML, Barini R, De Andrade KC, Milanez H, Simoni RZ, Peralta CF, Machado IN, Zambelli H, Maio KT. Congenital hydrocephalus: gestational and neonatal outcomes. Arch Gynecol Obstet. 2010;282(6):607-11 https://doi.org/10.1007/s00404-009-1254-2
10. Moutard ML, Kieffer V, Feingold J, Kieffer F, Lewin F, Adamsbaum C, Gélot A, Campistol I Plana J, van Bogaert P, André M, Ponsot G. Agenesis of corpus callosum: prenatal diagnosis and prognosis. Childs Nerv Syst. 2003;19(7-8):471-6 https://doi.org/10.1007/s00381-003-0781-6
11. Cavalheiro S, Sparapani FV, Moron AF, da Silva MC, Stávale JN. Fetal meningeal hemangiopericytoma. Case report. J Neurosurg. 2002;97(5):1217-20 https://doi.org/10.3171/jns.2002.97.5.1217
12. Stein SC, Feldman JG, Apfel S, Kohl SG, Casey G. The epidemiology of congenital hydrocephalus. A study in Brooklyn. Childs Brain. 1981;8(4):253-62 https://doi.org/10.1159/000119988
13. Baffero GM, Crovetto F, Fabietti I, Boito S, Fogliani R, Fumagalli M, Triulzi F, Mosca F, Fedele L, Persico N. Prenatal ultrasound predictors of postnatal major cerebral abnormalities in fetuses with apparently isolated mild ventriculomegaly. Prenat Diagn. 2015;35(8):783-8 https://doi.org/10.1002/pd.4607
14. Özkavukcu E, Haliloğlu N. Fetal Kraniospinal ve Fasiyal Anomaliler. Trd Sem 2017;5:211-33 https://doi.org/10.5152/trs.2017.511
15. Koyuncu Arslan M, Akar M, Pala HG, Taner CE, Oncel MY. Fetal Santral Sinir Sistemi Anomalilerinin Değerlendirilmesi; Referans Merkez Perinatoloji Konsey Verileri. Forbes J Med. 2020;1(3):75-78
16. Levine D, Barnes PD, Robertson RR, Wong G, Mehta TS. Fast MR imaging of fetal central nervous system abnormalities. Radiology. 2003;229(1):51-61 https://doi.org/10.1148/radiol.2291020770
17. Glenn OA, Barkovich AJ. Magnetic resonance imaging of the fetal brain and spine: an increasingly important tool in prenatal diagnosis, part 1. AJNR Am J Neuroradiol. 2006;27(8): 1604-11
18. Parazzini C, Righini A, Doneda C, Arrigoni F, Rustico M, Lanna M, Triulzi F. Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancy with no risk factor? Prenat Diagn 2012;32(8):752-7 https://doi.org/10.1002/pd.3896
19. Flick A, Krakow D, Martirosian A, Silverman N, Platt LD. Routine measurement of amniotic fluid alpha-fetoprotein and acetylcholinesterase: the need for a reevaluation. Am J Obstet Gynecol. 2014;211(2):139.e1-6 https://doi.org/10.1016/j.ajog.2014.02.005
20. Yayla M, Bayhan G, Yalınkaya A, Alp N, Fidanboy M, Görmüş H.Yüksek riskli gebeliklerde 2. trimester genetik amniyosentez: 165 olgunun klinik değerlendirilmesi. Perinatoloji Dergisi. 1999; 7(1):40-46
21. Leschot NJ, Verjaal M, Treffers PE. Risks of midtrimester amniocentesis; assessment in 3000 pregnancies. Br J Obstet Gynaecol. 1985;92(8):804-7 https://doi.org/10.1111/j.1471-0528.1985.tb03049.x
22. Stoll C, Dott B, Alembik Y, Roth MP. Evaluation of routine prenatal ultrasound examination in detecting chromosomal abnormalities in a low risk population. Hum Genet. 1993;91(1): 37-41 https://doi.org/10.1007/bf00230219
23. Lockwood DH, Neu RL. Cytogenetic analysis of 1375 amniotic fluid specimens from pregnancies with gestational age less than 14 weeks. Prenat Diagn. 1993;13(9):801-5 https://doi.org/10.1002/pd.1970130903
24. Eddleman KA, Malone FD, Sullivan L, Dukes K, Berkowitz RL, Kharbutli Y, Porter TF, Luthy DA, Comstock CH, et al. Pregnancy loss rates after midtrimester amniocentesis. Obstet Gynecol. 2006;108(5):1067-72 https://doi.org/10.1097/01.aog.0000240135.13594.07
25. Garne E, Loane M, Addor MC, Boyd PA, Barisic I, Dolk H. Congenital hydrocephalus--prevalence, prenatal diagnosis and outcome of pregnancy in four European regions. Eur J Paediatr Neurol. 2010;14(2):150-5 https://doi.org/10.1016/j.ejpn.2009.03.005
26. Yogi A, K C P, Neupane S. Prevalence and factors associated with abortion and unsafe abortion in Nepal: nationwide cross-sectional study. BMC Pregnancy Childbirth. 2018;18(1): 376 https://doi.org/10.1186/s12884-018-2011-y
27. Chae S, Desai S, Crowell M, Sedgh G, Singh S. Characteristics of women obtaining induced abortions in selected low- and middle-income countries. PLoS One. 2017;12(3):e0172976 https://doi.org/10.1371/journal.pone.0172976
28. Shapiro GK. Abortion law in Muslim-majority countries: an overview of the Islamic discourse with policy implications. Health Policy Plan. 2013,8:1-12 https://doi.org/10.1093/heapol/czt040
29. Cavli A, Ergocmen B. Ethno-cultural analysis of abortion and contraception: The cases of Turkey and selected Asian states. Nüfusbilim Dergisi. 2013;32–33
