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Mid-pregnancy ultrasound can detect risk of developmental delay

Obstetrics and gynaecology

Obstetrics and gynaecology

Mid-pregnancy ultrasound examination of the fetus is a screening test for fetal anomaly, but does it identify previously undiagnosed conditions and allow effective interventions to be made?

A fetal neurology unit in Israel analysed the outcomes of children identified in utero with abnormalities of the cerebral ventricles when imaged at 22 weeks' gestation. Fetuses were identified with either unilateral enlargement of a cerebral ventricle (n=20) or nonenlarged but asymmetrical ventricles (n=21) and were compared with a control group (n=20) with normal ventricles.

Progress was assessed carefully at 22-42 months (mean 32.1 months) after birth using a range of standardised tests that addressed mental, motor and behavioural development. The prevalence of the anomalies in the population the unit served was not stated.

Children with an antenatal unilateral ventricular enlargement were more likely to manifest mental and behavioural delays in development than children in the control group. Those with normal-sized but asymmetrical ventricles were more likely to have behavioural problems than children in the control group. These results were found to be statistically significant.

The prevalence of developmental delay in children with ventriculomegaly, children with asymmetrical ventricles and children in the control group was 20%, 15% and 5% respectively.

Mid-pregnancy scanning does identify conditions that were previously undiagnosed, but this information does not often make a clinical difference.

Identifying that cerebral ventricle abnormalities may imply that the child is slightly more at risk of neurobehavioural problems is interesting, but what will this translate into in clinical practice? This paper does not address the harm that will be caused to the families of ultimately normal children and the absence of beneficial intervention that might follow the diagnosis. How many parents of ultimately normal children (the majority) will suffer the uncertainty and heartache of being told that their child may have developmental or behavioural problems? And how many parents

of children who may be affected will be distressed to discover that nothing can modify the future risk?

Sadan S, Malinger G, Schweiger A et al. Neuropsychological outcome of children with asymmetric ventricles or unilateral mild ventriculomegally identified in utero. BJOG 2007;114:596-602

author Reviewer

Dr Chris Barclay
GP, Sheffield

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