Acceleration and plateau: two patterns and outcomes of isolated severe fetal cerebral ventricular dilation

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Objectives: We sought to characterize patterns of in utero dilation in isolated severe fetal ventriculomegaly (ISVM) and investigate their value in predicting obstetrical and postnatal outcomes. Methods: This is a retrospective cohort study. ISVM was defined as a sonographic cerebral ventricle atrial with width ≥15 mm in the absence of additional cerebral or other anatomic anomalies. The aim of this study was to characterize two ISVM groups using a receiver operator curve to evaluate the rate of ventricular progression versus need for ventriculoperitoneal (VP) shunt postnatally. Outcomes were compared between the groups using Pearson’s chi-squared test, Student t-test, and descriptive statistics. Results: Based on the ROC analysis, ventricular growth of ≥3 mm/week versus <3 mm/week distinguished fetuses likely to require a postnatal VP shunt. Fetuses were characterized as accelerators if ventricle growth was ≥3 mm/week at any point and plateaus if <3 mm/week. Accelerators showed a greater average rate of ventricle progression than plateaus (4.1 vs. 1.0 mm/week, respectively, p =.031) and were more likely to be delivered at earlier gestational ages (34.7 vs. 37.1 weeks respectively, p =.02). Ninety percent of accelerators demonstrated a need for shunt placement compared with 18.8% of plateaus (p <.001). Significantly more plateaus (87.5%) underwent a trial of labor while accelerators were more likely to have planned cesareans (70%, p =.009). Conclusions: This study characterizes ISVM into two distinct populations based upon the rate of ventricle expansion, differentiated by the need for postnatal shunting. Once a ventricular growth pattern is determined, these distinctions should prove useful in prenatal management and delivery planning.

Original languageEnglish (US)
Pages (from-to)3014-3020
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number18
StatePublished - 2021


  • Cerebral ventricles
  • fetal
  • hydrocephalus
  • ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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