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Objective: To describe the incidence and the prognostic value of foetal ventriculomegaly identified between 18-23 weeks of gestational age in the northeastern part of the Netherlands during the 2002-2010 period., Design: Retrospective cohort study., Method: From the database of the University Medical Centre Groningen in the Netherlands, we selected all cases of singleton pregnancies in which ventriculomegaly was diagnosed at 18-23 weeks of gestation., Results: In 2002, ventriculomegaly was diagnosed prenatally in 1:7000 foetuses; the incidence increased to 1:1750 in 2010. In 33 (51%) of 65 affected foetuses, an associated severe physical abnormality was detected, in 5 (8%) a subtle sonomarker (subtle ultrasound finding) and in 8 (12%), a chromosomal defect. In 47% of the pregnancies where ventriculomegaly was associated with other defects, the parents opted for termination of pregnancy. In the group with isolated mild ventriculomegaly (10-12 mm), termination was performed in 1 of 19 cases; and in the group with the greater ventricular width of 13-14 mm, this decision was made for 5 of the 8 pregnancies. All continued pregnancies of foetuses with isolated ventriculomegaly resulted in live births. Isolated ventriculomegaly was diagnosed relatively more frequently in male foetuses., Conclusion: The introduction of ultrasound scans as part of standard prenatal care has resulted in an increased incidence of foetal ventriculomegaly. Important factors for predicting the outcome of the pregnancy are the degree of ventricular dilatation, the foetus' gender and the presence or absence of associated abnormalities. It is therefore important to use a standardised protocol for measuring ventricular width, record the biparietal diameter and foetal gender, perform a systematic physical examination and use karyotyping.

Screening for Down's syndrome (DS) in the Netherlands is based on maternal age. Women aged 36 years or above are offered amniocentesis or chorionic villus sampling to determine if the foetus has Down's syndrome or other chromosomal abnormalities. Disadvantages of this method are a low detection rate of affected pregnancies (no more than 15%) and iatrogenic miscarriages (0.5-1%). Pregnant women under the age of 36 are not eligible for screening, even though 70% of the children with Down's syndrome are born in this age group. Screening by measuring nuchal translucency thickness, an early ultrasound marker for Down's syndrome carried out in the first trimester of pregnancy, has a higher detection rate with a less invasive method and therefore fewer iatrogenic miscarriages. However, Dutch law prohibits the offer of screening to women with a low individual risk of DS (Population Screening Act), because of the anxiety this may provoke in these women. The Dutch Health Council's Prenatal Screening Committee has advised the minister of Public Health, Welfare and Sport that risk-assessment screening, in particular the triple test, should no longer be postponed and that research into (other) screening options should be stimulated.

Objective: Evaluation of the diagnostic accuracy of ultrasound in the second trimester for the detection of spina bifida., Design: Systematic review and meta-analysis., Method: Medline and Embase were searched to identify prospective studies in a general pregnant population. Also, in the Cochrane Library, references of identified reports and recent reviews were checked for relevant studies. Retrieved abstracts were selected independently by 2 authors using predefined criteria. Assessment of quality and generalizability of the included studies and data extraction were performed by 3 authors independently. The data were tested for heterogeneity and pooled estimates of sensitivity and specificity were calculated for all studies., Results: 13 studies were included. Specificity was approximately 100% in all cases. Sensitivity varied from 40% to 100%. The summary point estimate for sensitivity was 71% with a 95% confidence interval of 59%-81%., Conclusion: Ultrasound in the second trimester is a specific investigation to detect spina bifida, which may detect seven out of ten defects. Used as a screening tool, it could contribute to a significant reduction in the number of children born with spina bifida.