**8. Discussion**

**Indicators. Groups Another group А+ Total** *χ***<sup>2</sup>** *Р* **OR**

Total 71 78.0 20 22.0 91 100.0 **Indicators Groups Another group O+ Total** *χ***<sup>2</sup>** *Р* **OR**

Miscarriage No 74 74.0 26 26.0 100 4.315 0.038 3.321

**Indicators Groups Without polygyria Polygyria Total** *χ***<sup>2</sup>** *Р* **OR**

**Agenesis of cerebellar vermis**

*N* **%** *N* **%** *N* **%** Abortion No 83 86.5 13 13.5 96 100.0 4.886 0.027 3.483

Total 97 89.1 12 11.0 109 100.0

Total 94 83.2 19 16.8 113 100.0

Total 93 83.0 19 17.0 112 100.0

Total 94 83.2 19 16.8 113 100.0

Abbreviations: No, number; CI, confidence intervals; OR, odds ratio; *χ*<sup>2</sup>

**Table 9.** Brain abnormalities, risk factors, and lethal hydrocephalus.

Risk factors No 47 90.4 5 9.6 52 100.0 3.898 0.046 3.463

Total 80 70.8 33 29.2 113

Abbreviations: No, number; CI, confidence intervals; OR, odds ratio; *χ*<sup>2</sup>

**cerebellar vermis**

**Table 8.** Blood groups, risk factors, and lethal hydrocephalus.

84 Congenital Anomalies - From the Embryo to the Neonate

**Indicators Groups Without agenesis of** 

Consanguinity first degree

Maternal age

Obstetric risk factors

А+ blood group

*N* **%** *N* **%** *N* **% (CI)**

First 8 57.1 6 42.9 14 100.0 (1.010–11.279)

*N* **%** *N* **%** *N* **% (CI)**

There are 6 46.2 7 53.8 13 (1.022–10.789)

*N* **%** *N* **%** *N* **% (CI)**

There are 11 64.7 6 35.3 17 100.0 (1.099–1.040)

There are 22 71.0 9 29.0 31 100.0 (1.048–8.052)

No 71 87.7 10 12.3 81 100.0 4.432 0.035 2.905

There are 19 73.1 7 26.9 26 100.0 (0.977– 12.274) total <sup>66</sup> 84.6 <sup>12</sup> 15.4 <sup>78</sup> 100.0

No 78 86.7 12 13.3 90 100.0 3.830 0.050 2.844

There are 16 69.6 7 30.4 23 100.0 (0.969–8.342)

, chi-square; *P*, sig.

≤35 82 92.1 7 7.9 89 100.0 4.894 0.027 4.894 (1.094–13.94) ≥35 <sup>15</sup> 75.0 <sup>5</sup> 25.0 <sup>20</sup> 100.0

, chi-square; *P*, sig.

**Total** *χ***<sup>2</sup>** *Р* **OR**

**(CI)**

No 63 81.8 14 18.2 77 100.0 4.206 0.04 3.375

Currently, prenatal ultrasound is able to visualize ventriculomegaly. Knowledge of the risk factors associated with CH may increase the success of the prenatal ultrasound study. It has been established that a wide range of factors can cause hydrocephalus in animal experiments including alcohol consumption [7], X-ray [8], infections, food disorders, exposure to chemicals [9] and medications taken during pregnancy [10].

Our study is similar to those of Fernell et al., Stoll et al., and Porto et al. which showed that CH was significantly associated with previous abortions, stillbirth, and birth of a child with a malformation [11–13]. Our findings show that the risk of FHLO is increased in cases of previous spontaneous abortions (odds ratio (OR) = 19.500, confidence interval (CI): 4.020–94.594), stillbirth (OR = 10.897; CI: 1.169–10.564), and births of a child with a malformation (OR=5.385; CI: 1.385–18.896). Pregnancy complications, such as an increase in the amniotic fluid over 1500 ml (polyhydramnios) or a reduction below 500 ml (oligohydramnios), are also considered as potential risk factors for CH [12, 13].

The role of consanguinity is also known for the occurrence of congenital malformations such as hydrocephalus, postaxial polydactyly of the hands, and defects of the lips and palate [13, 14]. In our study, FHLO is significantly associated with a maternal age over 40 years and third-degree consanguinity of the fetus (OR = 18.500; CI: 1.146–298.547). FHLO, previous pregnancies with malformations, and consanguinity are also significantly associated (OR = 7.309; CI: 1.806–29.584). FHLO with agenesis of the cerebellar vermis is significantly associated with the effect of obstetric risk factors (OR = 2.905; CI: 1.048–8.052).

Almost all studies have documented a slightly higher percentage of male fetuses in cases of CH in live births and stillbirths as well as in fetopathologic autopsies [15–18]. Van Landingham et al. did not find a difference in the genders of the children with hydrocephalus compared to the general population [4].

According to the study of Van Landingham et al. in 2009, the mother's age is not associated with CH, unlike the study by Sipek et al. for the period 1961–2000 in the Czech Republic which found that a mother's age over 37 years was significantly associated with CH [4, 6]. Hydrocephalus is significantly associated with a mother's age above 40 years and third-degree consanguinity, and it is 18 times higher compared to women above 40 years of age without consanguinity (OR = 18.500; CI: 1.146–298.547).

**9. Conclusion**

prenatal diagnosis.

**Author details**

Plovdiv, Bulgaria

**References**

03.009

\*, Borislav Kitov2

Neonatology of Tunis, Tunis, Tunisia

\*Address all correspondence to: tanyakitova@yahoo.com

, Denis Milkov4

1 Department of Anatomy, Histology and Embryology, Medical University of Plovdiv,

3 University of Tunis—El Manar, Faculty of Medicine of Tunis, Center of Maternity and

[1] Schechtman KB, Gray DL, Baty JD, Rothman SM. Decision-making for termination of pregnancies with fetal anomalies: Analysis of 53 000 pregnancies. Obstetrics and

[2] Benute GRG, Nomura RMY, Liao AW, et al. Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. Midwifery.

[3] Jeng S, Gupta N, Wrensch M, et al. Prevalence of congenital hydrocephalus in California, 1991-2000. Pediatric Neurology. 2011;**45**;67-71. DOI: 10.1016/j.pediatrneurol.2011.

Gynecology. 2002;**99**:216-222. https://doi.org/10.1016/S0029-7844(01)01673-8

2 Department of Neurosurgery, Medical University of Plovdiv, Plovdiv, Bulgaria

4 Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria

2012;**28**:472-475. DOI: 10.1016/j.midw.2011.06.011

and Aida Masmoudi3

Correlations between Ultrasound and Pathology in Fetal Ventricular System Anomalies

http://dx.doi.org/10.5772/intechopen.71934

87

Tanya Kitova1

Congenital hydrocephalus with a lethal outcome is the result of a significant number of risk factors and is often associated with other malformations. Therefore, it is important to perform a prenatal ultrasound study in pregnancies with risk factors to diagnose possible CH or other malformations. Currently, the prenatal ultrasound is able to visualize ventriculomegaly and should be directed toward the search of other associated malformations, and when they are suspected, an MRI study and genetic testing must follow. In cases of medical abortion, stillbirth, or neonatal death, a fetopathological study must be carried out which enriches our knowledge of malformations, complements and completes the ultrasound examination, modifies genetic counseling, and determines the behavior to be followed when taking responsibility for a subsequent pregnancy. It is also important to further study the associated risk factors and the fetopathological changes in CH in order to increase the success of the ultrasound

In regard to maternal disease, it is known that mothers suffering from diabetes mellitus have a significantly higher risk for giving birth to a child with congenital malformations, especially cardiovascular and neural tube defects [4, 19, 20].

Hydrocephalus is often divided by genetic specialists into a syndromic and non-syndromic form, depending on the presence of associated malformations [21, 22]. Some authors prefer to differentiate hydrocephalus in which the phenotype is characterized mainly with brain malformations and hydrocephalus which is associated with significant physical anomalies and clinical symptoms [23]. In cases with a specific clinical syndrome or genetic changes, hydrocephalus is best to be defined as hydrocephalus associated with the corresponding syndrome.

Some enzyme mutations result in defective neuron connections with the extracellular matrix, abnormal formation of the limiting glial membrane, and disturbances in the neuronal migration [24, 25]. As a result, characteristic brain malformation develops—loss of cerebral gyrification, abnormal white matter of the hemispheres as well as brainstem anomalies (flat pons, enlarged tectum, and curved medulla oblongata), often associated with an aqueductal stenosis and cerebellar cysts. These findings often cannot be found by the prenatal examination, especially in cases of significant ventriculomegaly, making the MRI study essential [26]. In our study, the risk increases almost five times for the association of FHLO and polygyria when the mother's age is above 35 years (OR = 4.894; CI: 1.094–13.94). The association of FHLO and agenesis of the cerebellar vermis is significantly associated with previous abortions (OR = 3.483; CI: 1.099– 1.040) and the effect of risk factors (OR = 3.463; CI: 0.977–12.274). Ventriculomegaly is significantly associated with agenesis of corpus callosum, as well as O(+) blood group of the mother, when compared to other blood groups (OR = 3.614; CI: 1.044–12.510). Hydrocephalus may be associated with other brain malformations such as holoprosencephaly, rhombencephalosynapsis, Aicardi syndrome, agenesis of corpus callosum, and periventricular heterotopia [27–31].

Some cytogenetic malformations are associated with hydrocephalus, including trisomy 13, 18, 21, and triploidy [32]. The trisomies in our study were 27 (24.1%) and their occurrence is significantly associated with a mother's age above 38 years (OR = 13.689; CI: 3.952–52.122).

NTD-associated hydrocephalus has a multifactor genesis. Experiments with animals have found that the intrauterine leak age of cerebrospinal fluid causes the Arnold-Chiari type II malformation, which causes an obstruction of the cerebrospinal fluid flow [33, 34]. Genetic mutations responsible for planar cell polarity such as Fuzzy (FUZ), VANGL1, and CELSR1 add to the development of NTDs [35–37]. Other mutations of genes with a relation to planar cell polarity (CELSR2 and MPDZ) may cause hydrocephalus regardless of the presence of NTDs [38, 39]. The specific pathogenetic mechanism is not completely clear, but it is accepted that a disjunction of the ependymal cilia is present [40]. The neural tube defects in our study were 33 (29.4%), with the most common being spina bifida, followed by myelomeningocele, encephalocele, and meningocele.
