Fetal macrocrania: diagnosis, delivery and outcomes.
OBJECTIVE
To describe fetal macrocrania including prenatal diagnosis, delivery considerations and clinical outcomes.


METHODS
A retrospective case series was developed by reviewing 26 885 ultrasounds performed between 1 March 2003 and 30 June 2007 for the prenatal diagnosis of macrocrania. Medical records of each mother/infant pair were reviewed for demographic information, ultrasound findings, obstetric management and outcomes.


RESULTS
Twenty-three fetuses were diagnosed with macrocrania. Median gestational age at diagnosis was 31.1 weeks (range 18.3-38.1) and at delivery was 36.9 weeks (range 30.7-39.9). Fifteen patients (65%) underwent amniocentesis for karyotype; none were aneuploid but one had a duplication on chromosome 7. All the 23 infants were liveborn. Twenty-one deliveries were by Cesarean (91%), with thirteen of these by classical incision (62%). Of the infants, 5 (22%) died shortly after birth, 16 (70%) were stabilized in the neonatal intensive care unit and were discharged alive and 2 (8%) were transferred to another center and subsequently died. Eighteen babies required ventriculoperitoneal shunting (78%).


CONCLUSIONS
Macrocrania is a diagnosis usually made in children but can also be made prenatally. Fetal macrocrania is usually a result of ventriculomegaly due to an obstructive process to cerebrospinal fluid flow. Abdominal delivery is usually required, often necessitating a classical uterine incision. Targeted ultrasonography, extensive counseling of parents and delivery at a tertiary care center with availability of neurosurgery is recommended.
Laye
M R
MR
Regional Maternal-Fetal Medicine, Spartanburg Regional Medical Center, Spartanburg, SC 29303, USA. m_ryan_laye@hotmail.com
Moore
B C
BC
Kosek
M A
MA
Bufkin
L K
LK
Morrison
J C
JC
Bofill
J A
JA
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000649:Amniocentesis; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012886:Skull / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult