No. 380-Investigation and Management of Prenatally Identified Microcephaly

J Obstet Gynaecol Can. 2019 Jun;41(6):855-861. doi: 10.1016/j.jogc.2018.10.014.

Abstract

Objective: To update Canadian maternity care and reproductive health care providers on the diagnostic criteria of fetal microcephaly and provide information on the relevant investigations, prognosis, and pre- and perinatal management of this prenatal finding.

Intended users: All maternity care (most responsible health provider [MRHP]) and pediatric providers; genetic counsellors; maternity nurses; nurse practitioners; provincial maternity care administrators; medical students; postgraduate residents, and fellows.

Outcomes: To provide better counselling and appropriate clinical management to women and families who have received a prenatal diagnosis of fetal microcephaly.

Evidence: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2018, using appropriate key words (prenatal ultrasound, prenatal imaging, fetal, antenatal, or prenatal microcephaly). Additional publications were identified from the bibliographies of these articles.

Search period: Seven years (2010-2018); completed final search April 19, 2018. The primary author completed validation of the articles.

Benefits, harms, and costs: This document educates readers about (1) the diagnostic criteria for fetal microcephaly, (2) its potential etiologies, (3) investigation and management options both pre- and postnatally. It proposes an evidence-based approach to the diagnosis and management of prenatally detected microcephaly. These recommendations are based on expert opinion and have not been subjected to a health economics assessment. Local or provincial implementation will be required. The authors recognize that there is variability across Canada in access to the cited services and resources. As such, these recommendations were developed in an attempt to promote access and to provide guidance for all provinces and territories across the country.

Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.

Keywords: Antenatal; fetal; fetal MRI; fetal imaging; fetal ultrasound; microcephaly; pregnancy; prenatal.

Publication types

  • Practice Guideline

MeSH terms

  • Alcohol Drinking
  • Autopsy
  • Canada
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / congenital
  • Disease Management*
  • Evidence-Based Medicine
  • Female
  • Genetics, Medical
  • Humans
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Maternal Exposure
  • Metals, Heavy
  • Microcephaly / diagnosis*
  • Microcephaly / diagnostic imaging
  • Microcephaly / etiology
  • Perinatology*
  • Pregnancy
  • Prenatal Diagnosis
  • Radiation Exposure
  • Referral and Consultation*
  • Smoking
  • Tertiary Care Centers
  • Ultrasonography, Prenatal

Substances

  • Metals, Heavy