SMFM Clinical Practice Guidelines - PowerPoint Presentation

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SMFM Clinical Practice Guidelines

Isolated fetal choroid plexus cysts

Society of Maternal Fetal Medicine with the assistance of Karin M. Fuchs MD

Published in

Contemporary OB/GYN /

April

2013

Incidence/Definition

A choroid plexus cyst is a small fluid-filled structure within the choroid of the lateral ventricles of the fetal brain. Sonographically

, choroid plexus cysts appear as echolucent cysts within the echogenic choroid. Choroid plexus cysts may be single or multiple, unilateral or bilateral, and most often are less than 1 cm in diameter. Choroid plexus cysts are identified in approximately 1% to 2% of fetuses in the second trimester and they occur equally in male and female fetuses

Major clinical implications of an isolated choroid plexusWhen a choroid plexus cyst is identified, the presence of structural malformations and other

sonographic markers of aneuploidy should be assessed with a detailed fetal anatomic survey.Detailed examination of the fetal heart (4-chamber view and outflow tracts view) and hands (for “clenching” or other abnormal positioning) should be included, as well as fetal biometry for assessment of intrauterine growth restriction.

Major clinical implications of an isolated choroid plexus

A choroid plexus cyst is not considered a structural or functional brain abnormality. Most choroid plexus cysts are isolated and occur in otherwise low-risk pregnancies.The only association of some significance between an isolated choroid plexus cyst and a possible fetal problem is with trisomy 18.

Choroid plexus cysts are present in 30% to 50% of fetuses with trisomy 18. When a fetus is affected by trisomy 18, multiple structural anomalies are almost always evident, including structural heart defects, clenched hands, talipes deformity of the feet, growth restriction, and polyhydramnios. When a structural anomaly is present in addition to choroid plexus cysts, the probability of trisomy 18 is 37%.In the absence of associated

sonographic

abnormalities, the likelihood of trisomy 18 is extremely low in otherwise low-risk pregnancies.

Counseling

Counseling for a woman after prenatal identification of a fetal choroid plexus cyst should be guided by the presence or absence of other sonographic markers or structural abnormalities, results of maternal screening for risk of trisomy 18 (if performed), and maternal age

Follow up

More than 90% of choroid plexus cysts resolve, most often by 28 weeks.Studies evaluating neurodevelopmental outcomes in

euploid children born after a prenatal diagnosis of choroid plexus cysts have not shown differences in neurocognitive ability, motor function, or behavior. Therefore, neither serial antenatal ultrasounds nor post-natal evaluation are clinically useful. 

The practice of medicine continues to evolve, and individual circumstances will vary. This opinion reflects information available at the time of its submission for publication and is neither designed nor intended to establish an exclusive standard of perinatal care. This presentation is

not expected to reflect the opinions of all members of the Society for Maternal-Fetal Medicine.

These slides are for personal, non-commercial and educational use onlyDisclaimer

DisclosuresThis opinion was developed by

the Publications Committee of the Society for Maternal Fetal Medicine with the assistance of Stanley M. Berry,

MD, Joanne Stone, MD, Mary Norton, MD, Donna Johnson, MD, and Vincenzo Berghella, MD, and was approved by the executive committee of the society on March 11, 2012. Dr Berghella and each member of the publications committee (Vincenzo Berghella, MD [chair], Sean Blackwell

, MD [vice-chair],

Brenna Anderson

, MD, Suneet P. Chauhan,

MD, Jodi

Dashe, MD, Cynthia

Gyamfi-Bannerman, MD, Donna

Johnson

, MD

,

Sarah Little

, MD, Kate Menard, MD,

Mary Norton

, MD, George Saade, MD,

Neil Silverman

, MD, Hyagriv Simhan,

MD,

Joanne

Stone, MD, Alan Tita,

MD,

Michael

Varner, MD) have submitted

a conflict

of interest disclosure

delineating

personal, professional, and/or

business interests

that might be perceived as a

real or

potential conflict of interest in

relation to

this publication.