Outcome of fetuses with prenatal diagnosis of isolated severe bilateral ventriculomegaly: A systematic review and meta-analysis.

Objective To quantify from the published literature survival and neurodevelopmental outcome of fetuses with prenatally detected isolated severe bilateral ventriculomegaly. Methods MEDLINE, EMBASE and the Cochrane Library were searched electronically. Only cases with a prenatal diagnosis of apparently isolated severe ventriculomegaly and postnatal neurodevelopmental assessment were selected and included. Severe ventriculomegaly was defined as enlargement of the ventricular atria, with a diameter of greater than 15 mm in the transventricular plane. All cases in which the investigators were unable to detect associated structural abnormality, chromosomal abnormality or fetal infection, and in which the ventriculomegaly was therefore regarded as apparently isolated, were included. Those for which the etiology was identified prenatally were excluded, whereas those with postnatal identification of the underlying cause were not excluded, since this information was not available prenatally. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies. Pregnancy outcomes such as termination, stillbirth, neonatal survival and developmental outcome of the baby, were recorded. The degree of disability was classified as no, mild or severe disability. Statistical assessment was performed by meta‐analysis of proportions to combine data, weighting the studies using the inverse variance method and a random‐effects model. Proportions and CIs were reported. Results Eleven studies including 137 fetuses were found. Twenty‐seven pregnancies underwent termination and were excluded. The remaining 110 fetuses with apparently isolated severe ventriculomegaly for which continuation of pregnancy was intended, form the study population. Overall quality assessed using NOS for cohort studies was good. Survival was reported in 95/110 (pooled proportion 87.9% (95% CI, 75.6–96.2%)) cases. In 15/110 (pooled proportion 12.1% (95% CI, 3.8–24.4%)), either stillbirth or neonatal demise was reported. No disability was reported in 41/95 survivors (pooled proportion 42.2% (95% CI, 27.5–57.6%)). However, 17/95 showed mild/moderate disability (pooled proportion 18.6% (95% CI, 7.2–33.8%)) and 37/95 were reported to have severe disability (pooled proportion 39.6% (95% CI, 30.0–50.0%)). Conclusions Four‐fifths of fetuses with severe ventriculomegaly survive and, of these, just over two‐fifths show normal neurodevelopment. The overall survivors without disability account for more than one third of the total. Given that many cases undergo termination of pregnancy and require longer follow‐up in order to detect subtle abnormalities, mortality and prevalence of developmental delay may be even higher than that reported in this paper

A pilot study to evaluate the practice of transvaginal gynecological sonography in a general gynecology clinic

PURPOSE: Ultrasound is the imaging method of choice in gynecology. The quality and diagnostic accuracy of ultrasound depends on the skills of the individual performing the scan. Evaluation of ultrasound practice has received limited attention. METHODS: A video recording device was connected to an ultrasound machine in gynecology clinics in a teaching hospital. To minimize the observer effect, all staff were notified through email in advance. Data were collected over a 3-week period. Anonymous recordings of both patients and user were compared with current guidelines, and practice was categorized as: compliant, partially compliant, or non-compliant. RESULTS: Observations (n = 43) were categorized and the results described as percentage frequencies (%). Image optimization was compliant in 23.3% of recorded observations, 11.6% was partially compliant, and 65.1% was noncompliant. The study also found that global examination on gynecology was 20.9% compliant, 18.6% partially compliant, and 60.47% noncompliant. Images were annotated in appropriately 41.9% of instances, and 25.6% of end-users examined bladder, vagina, and cervix when indicated. CONCLUSION: The pilot evaluation showed that ultrasound practice among end-users did not reflect current guidelines, suggesting a need for improvement. Accuracy and performance of ultrasound examination remains highly operator-dependent although video evaluation can be an effective tool for assessing such skills