Skip to main content
  1. Right Decisions
  2. Maternity & Gynaecology Guidelines
  3. Maternity
  4. Back
  5. Ultrasound
  6. Mild Ventriculomegaly on Antenatal Ultrasound (916)
Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Mild Ventriculomegaly on Antenatal Ultrasound (916)

Warning Warning: This guideline is 372 day(s) past its review date.
Please report any inaccuracies or issues with this guideline using our online form

Fetal ventriculomegaly is a common finding on antenatal ultrasound and is defined as an atrial measurement of ≥ 10mm of the posterior horn of the lateral ventricle (1). It can be further subdivided into mild 10-12mm, moderate 13- 15mm and severe >15mm (2). It has a prevalence of approximately 1% (3). Ventriculomegaly has a range of causes; normal variation, aneuploidy, genetic syndromes, primary brain structural abnormalities, congenital infections, cerebrovascular accidents and intracranial haemorrhage. Prognosis and corresponding counselling of the parents is dependent on the cause of the ventriculomegaly, the antenatal progression and any co-existing abnormalities(4). It is therefore vitally important to look for  any underlying aetiologies and co-existing CNS and non-CNS abnormalities in order to present the parents with the most relevant and accurate information.

Accurate measurement of the ventricles is important in both defining ventriculomegaly and also assessing progression. The fetal head should be scanned in the axial plane at the level of the frontal horns and the cavum septum pellucidum (CSP) (the same level at which a head circumference is taken), at an appropriate magnification that the head fills the screen. The callipers should be placed at the internal margins of the atrial walls at the level  of the parietal occipital groove and the glomus of the choroid plexus, perpendicular to the axis of the ventricle.

Although the distal ventricle is always easier to see than the proximal one because of reflection of the ultrasound beams from the fetal skull, both ventricles should be checked; ventriculomegaly is unilateral in 50-60% cases and bilateral in 40-50% (5).

Once ventriculomegaly has been diagnosed, there should be a detailed, sonographic evaluation of the neuroanatomy by a medical sonographer. Whether this is by transabdominal or transvaginal ultrasound will depend on the preference of the patient, the sonographer and the fetal position.

Other, non-CNS structures should also be carefully assessed including fetal biometry looking for evidence of growth restriction, the heart and any markers of intrauterine infection.

Parents should be offered invasive, diagnostic testing and chromosomal microarray (CMA). 

Between 0-5% (2, 5) of fetuses with apparently isolated m i l d ventriculomegaly will have an underlying abnormal karyotype, most commonly Trisomy 21 and a further 10-15% will have abnormalities found on CMA.  

Congenital infections, most commonly cytomegalovirus (CMV), toxoplasmosis, parvovirus and Zika have been associated with mild ventriculomegaly in around 8% of cases (5). Parents should be offered tests for CMV, toxoplasmosis and parvo virus (regardless of history of known exposure or symptoms). Women with mild fetal ventriculomegaly who have been to a Zika area and not yet tested should be offered a test.

Fetal MRI (fMRI) can be a useful adjunct to ultrasound if the relevant radiological expertise and technology is available. The additional information will depend on the size of the ventricles as well as the quality of the original ultrasound and the level of expertise in the practitioner. The chance that fMRI will find important, clinically relevant additional brain abnormalities not picked up on ultrasound varies in the literature from 1-14% with the most recent studies putting the figure at 5-6% (5). The most common abnormality picked up on fMRI after being missed on ultrasound is agenesis of the corpus callosum.

Women wishing to have a fetal MRI, to look for additional brain abnormalities that may affect the prognosis, after appropriate counselling should be referred to fetal medicine department for review.

  • The fetal medicine department will arrange the MRI
  • Fetal medicine will review again after MRI to discuss results.
  • Thereafter the patient will go back to their own unit, unless otherwise indicated and delivery will be planned in their own unit.

There are no data on optimal timings of follow up assessments once a diagnosis has been made. A suggested pragmatic approach would be 4-weekly assessments. Progression of ventriculomegaly is an important prognostic indicator; evidence suggests that 5% progress during pregnancy (5).

The timing and mode of delivery should be planned as per normal obstetric indications. An alert should be placed on the electronic BadgerNet record to ensure that neonatologists are made aware of the antenatal diagnosis.

Cord bloods should be taken with parental consent for chromosomal analysis and congenital viral infections from those infants who didn’t have antenatal testing.

Postnatal follow up should be arranged by the neonatologists prior to discharge from hospital.

Most of the statistics quoted in the literature are based on whether the ventriculomegaly is apparently isolated or not; true isolation will only be able to be confirmed postnatally. Neurodevelopmental delay in case of isolated unilateral mild or moderate ventriculomegaly is thought to be 6% (5); in bilateral isolated ventriculomegaly this rises to 8-12% (7). This may not be dramatically higher than the background population risk. Long-term prognosis also depends on associated findings and the positive results of any investigations. 

Parents should be offered antenatal counselling by paediatricians to discuss prognosis and postnatal care in greater detail. A patient information leaflet from ISUOG and a link to further information is below.

Melchiorre, K & Bhide, Amarnath & Gika, Artemis & Pilu, G & Papageorghiou, A.T. (2009). Counseling in isolated mild ventriculomegaly. Ultrasound in Obstetrics & Gynecology

Patient Information:

ISUOG. Ventriculomegaly
"This leaflet is to help you understand what Ventriculomegaly is, what tests you need, and the implication of having been diagnosed with Ventriculomegaly for you, your baby and your family."

Editorial Information

Last reviewed: 01/04/2021

Next review date: 01/04/2024

Author(s): Rachel Bradnock.

Approved By: Obstetrics Clinical Governance Group

Document Id: 916

References
  1. International Society of Ultrasound in Obstetrics and Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’. Ultrasound Obstet Gynecol 2007; 29: 109 – 116.
  2. Society for Maternal-Fetal Medicine (SMFM): Fox NS et al. Mild Fetal Ventriculomegaly: diagnosis, evaluation and management. SMFM Consult Series 45 2018.
  3. Pilu G, Hobbins JC. Sonography of fetal cerebrospinal anomalies. Prenat Diagn 2002; 22: 321 – 330.
  4. Scala C, Familiari A, Pinas A, Papageorghiou T, Bhide A, Thilaganathan B, Khalil A. Perinatal and long-term outcomes in fetuses diagnosed with isolated unilateral ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49: 450–459
  5. Griffiths PD, Brackley K, Bradburn M, et al. Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly. Ultrasound Obstet Gynecol 2017;50:736-44.
  6. RCOG/RCM/PHE/HPS Clinical Guidelines. Zika Virus Infection and Pregnancy. Updated Feb 2019.
  7. Pagani G, Thilaganathan B, Prefumo F. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014; 44: 254 – 260.