Enlarged ventricle in brain

[quietmim]

I am 30 weeks pregnant and just had a followup ultrasound to check the placement of my placenta as it was considered low lying at 20 weeks.  At 20 weeks they also saw an echogenic focus (calcium deposit) in the  heart which can be a soft marker for Downs Syndrome.  My understanding was that given my age, 28, and the lack of other risk factors, markers, or abnormalities, that the chance of Downs was something under or around 1%.

So, at this last ultrasound, they did pretty much another full scan.  The location of my placenta is fine now, which I was told was what was expected as the pregnancy progressed.  But, they noticed a mildly enlarged left ventricle of the brain.  Normal is 10 mm and we are talking about 10.8, I believe.  The doctor said usually when they see a serious problem it is much larger than that, and he suspects nothing serious is going on.  The concern, he explained to me, is hydrocephalus and perhaps the baby will need ultrasounds of her brain after she is born.  The Internet says that most outcomes with these mild enlargements are good, BUT up to 20% have some type of developmental delay.  And now I don't know what to think.

Given the echogenic focus and now this, I vacillate between being sure there is something wrong with this baby and being angry about these ultrasounds that have only raised questions and given me no answers.  Two days ago I was imagining breastfeeding another little one and thinking about what little outfit she should wear coming home, and now I am thinking about how I had no business getting pregnant again (I take medication that is generally considered safe, but..., was it just luck that my first was healthy? my daughter will only be 23 months when I am full term, she isn't ready, it will be hard on her to have a sister with special needs...  you know, the gamut of negative thoughts that I hadn't been entertaining until this point).

The doctor recommended another scan with a perinatologist.  Nothing they see will change how the pregnancy is managed at this point, he said.  The Internet did mention that there can be concern with head size and a vaginal delivery, but that doesn't seem to be an issue here.  I believe the question is what kind of care and workup the baby might need after birth.  I feel as if I know how that appointment is going to go, they will see the same things, have no further information, and then offer me an amniocentesis.  I am not sure that I want that.  I am not sure what I am expected to do with the information that procedure will provide.  I suppose I would be more prepared if it showed a high likelihood of a genetic abnormality, but isn't it more than possible it will just raise more questions?  When I started to raise these points with the doctor, that these detailed ultrasounds have only served to cause me heartache, he said he sometimes feels that way, too.   But, maybe it is better to catch things that wouldn't otherwise be caught.  It is just that, I wouldn't even have had a third trimester US if the placenta wasn't low, and everyone expected that would resolve anyway.  And, if the baby does have hydrocephalus, wouldn't that be caught during a physical exam with her pediatrician?  

I guess I am wondering if anyone else has dealt with a similar set of circumstances (even if the stories might be scary).  BTW, I am with a midwife practice ( saw the doc yesterday due to scheduling concerns, he is their backup) and believe in less intervention.  I really only did the first scan due to guilt and concern about the medication I am taking.  But once I did that one scan, I set all of this into motion.   I realize the best set of circumstances is me coming away from this with a healthy baby and an anecdote about the harm all these screenings can do.  And even if the baby does have medical problems, if there was no difference in the way my pregnancy was managed, and nothing to be done before the baby is born, is what we are going through now the best thing for an already stressed mama with a full time job and toddler at home?  I am also well aware that lives are saved by these kinds of technologies...  It just really is a lot to think about.

Thanks for reading if you got all of the way through that.  I don't post much, but I am an avid reader here, and couldn't imagine not sharing this with what I consider to be my community.  I think a desire to express myself is the main reason I posted this.  Thanks in advance for any info anyone has.

[SGVaughn]

ok...I just went through something a little like what you're going through now..only they couldn't see brain ventricles on one side at ALL and the tech thought she saw possible "lemon sign" ...which if you make the mistake of googling is horrific terror inducing. I sobbed for a day.

the OB was NOT very concerned but it still really upset me ..she referred me to a peri and you know what? I'm glad I went. The peri is the scarey baby/mom doctor BUT they know their stuff. Its what they see day in and day out...they should be able to very quickly and accurately either confirm any fears or dismiss them. For my own visit they very quickly looked over the small fry and came up with a very clean bill of health and they kind of poo-pooed the techs ability and the equipment used at the OB's office. I felt better about their skill level then the random tech at the OB's office. I know just hearing the word perinatologist is stress provoking but it could really make you feel better about things too, at the very least to help you know where you stand.

And yeah, I can feel where you're coming from about endless strings of testing that get no answers, and really seem like they have no point..I felt very frustrated/sad/scared too and in my case if it had been accurate birth would've had to of been managed very differently and I still felt like wth with the already stressed, working, student, 4 kids a husband and a dog ...I don't need this kinda attitude.

I would very surprised if the peri wanted to do an amnio based on such a small discrepancy. I'd probably do it just so the baby didn't have to undergo a bunch of testing after birth, kwim?

[quietmim]

I am going to ask if anything we might do now could spare the baby after birth.  Thanks, that is something to think about.

[Italiamom]

I might not have the most comforting information, but I will weigh in anyway in hopes that it might be helpful.

With DS, I did 1 ultrasound at 20 weeks.  Our midwife of course leaves it up to clients, but she thinks that doing 1-2 ultrasounds can provide valuable information, and I had no problem with it then.  In the ultrasound, DS looked healthy, but the doctor diagnosed a velamentous cord insertion, and while he said it wasn't bad, I googled it and spent the next 10 weeks terrified.  Our insurance was a little wonky with DS, so that first ultrasound was paid for out of pocket.  Once the insurance kicked in, at 30 weeks I went to a perinatologist, who diagnosed it as either a SLIGHT velamentous insertion, OR a battle door insertion.  One carries more risks than the other...  The perinatologist DID help me feel better about things, I think mainly because explaining scary situations is his job.  And he seemed unconcerned by it, so that helped me feel more at ease (BUT, I was also fortunate enough to see a perinatologist who wasn't anti-homebirth...  I hear they are unicorn rare).

It ended up just being a battle door cord insertion.  No risk, easy peasy.  I spent 10 weeks crying almost every day, worrying to no end, for NO reason.

Another case in point, which probably isn't the exact info your looking for, again.  But one of my very dear friends just recently had a beautiful, healthy baby girl (5 weeks now, so sweet).  Mom is also age 28, no history of down's, good health, etc.  In her first ultrasound, they found what they thought were calcium deposits in the brain, or maybe heart (I can't remember which, I'm sorry), which were markers for down's.  And they also tracked a strange heart rhythm, which was another marker for down's.  The perinatologist pushed and pushed for amniocentesis, which my friend didn't want (she said it wouldn't change the outcome of the pregnancy, so why take the risk).  Anyhow, there were a cascade of subsequent ultrasounds, which ended up being mostly inconclusive, and it stressed my poor friend to no end.  The ultrasounds did glean enough information that eventually her midwives were comfortable continuing care, and she went on to have a totally normal, totally healthy little one.

I'm pregnant again, and honestly, this time around, it's up for debate whether we'll do an ultrasound at all.  On the one hand, I know it offers a great chance to find out about complications that could add extra risk to births, or require a NICU, etc.  But I have seen mama after mama in real life go to have an ultrasound, only to be informed of this or that potential disaster, stress to high hell about it, and then have a totally normal kid.  I could list more examples, I've SO got them, but I think you get my point.

On another note, the one down's baby that I know in real life was the sweetest, most well behaved little baby (she's a toddler now).  She had some medical issues, yes, but it was as though she was making up for that hardship (hardship isn't even the right word) to her mama by being super amazing in other ways.  I don't think I ever saw her cry, she was a good sleeper...  Her mama said that she was difficult in different ways, but not necessarily more difficult than her older brothers.

I'm sorry you're going through this mama.  Big hugs to you!  Getting inconclusive results from an ultrasound is MADDENING.

[kmg5]

I'm also in a similar situation. At our 20 week u/s we were told our baby girl had mild bilateral pyelectasis, extra fluid in the kidney's, which is a soft marker for downs. We have had a few followup u/s thoughtout the pregnancy. At 28 weeks, they had grown slightly. At 33 weeks they had gone down, one is considered normal now and the other is only slightly enlarged, so we were relieved. However, at the end of the ultrasound the tech said she didn't want to alarm us but there is a small amount of fluid in the left ventricle. It was 9mm, so it is still considered normal, but on the high side. I'm not sure what to think, of course the dr. had no answers, but emailed a specialist who I will be seeing for another u/s on monday and she said that because it is still in the normal range she is not concerned and the kidney's seem to be correcting themselves, which often happens. She will take a more accurate measurement of everything on Monday, but until then I keep googling and stressing myself out. Anyone with any info or other similar experiences would sure help with the anxiety.

[Bird Girl]

My son had the same pyelectasis at his 20 week ultrasound. I was very worried (I think there's something almost hard-wired about the fear a pregnant woman can feel about her baby's health) but my DH was able to remain pretty calm. We did not have an amnio, but instead opted for the quad screen blood test, to see if more testing would be needed. His odds of chromosomal trisomy were very low, so we opted not to have further testing, and a follow-up ultrasound showed that the pyelectasis had resolved itself.

For what it's worth, I understand that some babies with pyelectasis need post-partum care for their kidneys, and that they are at higher risk for chord accidents because their amniotic fluid can drop too much toward the end of pregnancy. So it's information that's worth having, because the baby may need follow-up care. Also, while it can be a marker for Down's, otherwise healthy babies can have kidney issues that need treatment. So don't beat yourself up about having the extra information.

It is stressful, though. Hang in there, Mama. I will keep my fingers crossed for an easy resolution, without any other issues.

[kmg5]

The appointment with the specialist went well, she looked at the brain right away and said that it looks fine to her and the fluid is normal, she's not worried about it at all. The kidney's are also considered normal at this stage just on the high end, she said that they may need followup at birth with an ultrasound or maybe some antibiotics to make sure the baby doesn't get a urinary tract infection. She took measurements of the kidneys a few different times and I couldn't believe how much they fluctuate! Every few seconds the reading was different. Other than that, she said she is not worried at all, maybe 1 more scan before the birth, I am so sick of the worrying and fear that comes with these ultrasounds though, I think we may elect not to. Seems like too much information and if you look hard enough you will always be able to find something "questionable". I am definitely more at ease, but won't be completely until I have my little girl in my arms!

[HappyMonkey]

Someone I know got the quad screen done and was told one of her twins had serious markers for a genetic defect that meant she would probably die at birth. She opted not to do amnio for fear of miscarriage but spent the rest of her pregnancy terrified and crying. Both babies were JUST FINE. I think often these tests cause so much fear... I am not having them personally.

[Italiamom]

Originally Posted by kmg5 

The appointment with the specialist went well, she looked at the brain right away and said that it looks fine to her and the fluid is normal, she's not worried about it at all. The kidney's are also considered normal at this stage just on the high end, she said that they may need followup at birth with an ultrasound or maybe some antibiotics to make sure the baby doesn't get a urinary tract infection. She took measurements of the kidneys a few different times and I couldn't believe how much they fluctuate! Every few seconds the reading was different. Other than that, she said she is not worried at all, maybe 1 more scan before the birth, I am so sick of the worrying and fear that comes with these ultrasounds though, I think we may elect not to. Seems like too much information and if you look hard enough you will always be able to find something "questionable". I am definitely more at ease, but won't be completely until I have my little girl in my arms!

I'm happy that the specialist seemed to be optimistic!  That's wonderful!  It has been my experience that when specialists are optimistic, it means things are fine.  They can't tell you for sure "oh, everything will be perfect and fine," because that would leave them open to liability, but if she didn't concerned, then I'd be pretty stinkin' happy about it!  I'm glad for you that everything fell in the good range!

[kmg5]

Just wanted to give an update- I gave birth to my daughter via c-section Thursday March 24th, she was born weighing 8 lbs 11 oz. and does not have DS. She also seems to be urinating fine. We are scheduled to have an ultrasound done on her kidney's soon to see if the enlargement went down. The pediatritians all said that this finding is so common due to the technology of u/s today. They seem to think it will be considered  normal finding soon and that in the past 7 years of all the cases they have seen with it, only one ended up needing surgery to correct. Just wanted to help calm any others fears out there and to also thank everyone on this board for their support in probably one of the most stressful times of my life!

[HawaiianBlesing]

Congratulations on the birth of your daughter!

[SGVaughn]

congratulations on the new baby and glad everything seems to be working out for her health :)

[Bird Girl]

Great news! Enjoy your baby girl!