Published: 2020-01-28

Evaluation of the incidence, risk factors, severity, and outcome of hydrocephalic fetuses in a tertiary healthcare center located in Northern India: a prospective observational study

Aditi Jain Garg, Rehana Najam, Ritika Agarwal, Rajul Rastogi


Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.

Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.

Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.

Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis.


Low socioeconomic status, Prenatal hydrocephalus, Ventriculomegaly, Ventriculo-peritoneal shunt

Full Text:



Isaacs AM, Riva-Cambrin J, Yavin D, Hockley A, Pringsheim TM, Jette N, et al. Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One. 2018;13:e0204926.

Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, et al Global hydrocephalus epidemiology and incidence: a systematic review and meta-analysis. J Neurosurg. 2018;27:1-15.

Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014;57:359-68.

Tully HM, Ishak GE, Rue TC, Dempsey JC, Browd SR, Millen KJ, et al. Two hundred thirty-six children with developmental hydrocephalus: causes and clinical consequences. J Child Neurol. 2016;31(3):309-20.

Zhang J, Williams MA, Rigamonti D. Genetics of human hydrocephalus. J Neurol. 2006;253:1255-66.

Kalyvas AV, Kalamatianos T, Pantazi M, Lianos GD, Stranjalis G, Alexiou GA. Maternal environmental risk factors of congenital hydrocephalus: a systematic review. Neurosurg Focus. 2016;41:E3.

Venkataramana NK. Hydrocephalus Indian scenario: a review. J Pediatr Neurosci. 2011;6:S11-S22.

Cavalheiro S, Silva da Costa MD, Mendonca JN, Dastoli PA, Suriano IC, Barbosa MM, et al. Antenatal management of neurosurgical diseases. Childs Nerv Syst. 2017;33:1125-41.

Letouzey M, Chadie A, Brasseur-Daudruy M, Proust F, Verpyck E, Boileau P, et al. Severely apparently isolated fetal ventriculomegaly and neurodevelopmental outcome. Prenat Diagn. 2017;37:820-6.

Fox NS, Monteagudo A, Kuller JA, Craigo S, Norton ME, Society for Maternal-Fetal Medicine (SMFM. Mild fetal ventriculomegaly: diagnosis, evaluation, and management. Am J Obstet Gynecol 2018;219:B2-9.

Bijarnia-Mahay S, Puri RD, Kotecha U, Dash P, Pal S, Lall M, et al. Outcome of prenatally-detected fetal ventriculomegaly. J Fetal Med. 2015;2(1):39-44.

Gagilioti P, Danelon D, Bontempo S, Mombro M, Cardaropoli S, Todros T. Fetal cerebral ventriculomegaly: outcome of 176 cases. Ultrasound Obstet Gynecol. 2015;25:372-7.

Sharma R, Saini NK. A critical appraisal of Kuppuswamy’s socioeconomic status scale in the present scenario. J Family Med Prim Care. 2014;3:3-4.

Breeze AC, Alexander PM, Murdoch EM, Missfelder-Lobos HH, Hackett GA, Lees CC. Obstetric and neonatal outcomes in severe fetal ventriculomegaly. Prenat Diagn. 2007;27:124-9.

Chiu TH, Haliza G, Lin YH, Hung TH, Hsu JJ, Lo LM. A retrospective study on the course and outcome of fetal ventriculomegaly. Taiwan J Obstet Gynecol. 2014;53:170-7.

Williams MA, Malm J. Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). 2016;22:579-99.

Twining P, Jaspan T, Zuccollo J. The outcome of fetal vetriculomegaly. Br J Radiol. 1994;67:26-31.

Smith J, Cheater F, Bekker H. Parent’s experiences of living with a child with hydrocephalus: a cross-sectional interview-based study. Health Expect. 2015;18:1709-20.

Del Bigio MR, Di Curzio DL. Nonsurgical therapy for hydrocephalus: a comprehensive and critical review. Fluids Barriers CNS. 2016;13:3.