Background:Fetal ventriculomegaly is a common antenatally detected central nervous system abnormality with diverse etiologies and outcomes. The severity and laterality of ventriculomegaly, along with associated anomalies, play a critical role in determining prognosis. This study aimed to assess the severity-wise distribution of ventriculomegaly, its correlation with gestational age, laterality, associated structural anomalies, and postnatal outcomes using antenatal ultrasound in a tertiary care setting.

Methods:This retrospective cross-sectional study was conducted at a tertiary care hospitals, including 137 singleton pregnancies diagnosed with fetal ventriculomegaly between 18 and 36 weeks of gestation from January 2020 to December 2023. Antenatal ultrasound data were analyzed to classify ventriculomegaly as mild (10–12 mm), moderate (13–15 mm), or severe (>15 mm). Laterality, associated anomalies, follow-up progression, and pregnancy outcomes were recorded and statistically analyzed using Chi-square tests.

Results:Mild, moderate, and severe ventriculomegaly were observed in 40.8%, 29.2%, and 30.0% of cases, respectively. Bilateral involvement was significantly associated with severe cases (85.4%, p < 0.001), while unilateral ventriculomegaly predominated in mild cases (73.2%). Structural anomalies were present in 57.7% of fetuses, with hydrocephalus (15.3%) and cardiac defects (13.1%) being the most common. The incidence of associated anomalies increased significantly with severity (p < 0.001). On follow-up, 43.9% of mild cases resolved, while severe cases showed a higher rate of progression and termination of pregnancy (28.9%, p < 0.001). Live births with normal outcomes were highest in the mild group (41.5%).

Conclusion:The severity and laterality of ventriculomegaly are significant predictors of associated anomalies and fetal outcomes. Mild, isolated, unilateral ventriculomegaly is associated with favorable prognosis, whereas severe and bilateral forms often correlate with CNS anomalies and adverse outcomes. Detailed anomaly evaluation and longitudinal follow-up are essential for prognostication and counseling.