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#1
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Dolichocephalic head
i am 31Weeks 2Days pregnant.... USZG shows mild oligohydramnios with
fetus in breech position... the head is dolichocephalic in shape with CI= 67%... dr says that the head is abnormal.... i am worried abt this.... can anyone pls help |
#2
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Dolichocephalic head
Shabeena wrote: i am 31Weeks 2Days pregnant.... USZG shows mild oligohydramnios with fetus in breech position... the head is dolichocephalic in shape with CI= 67%... dr says that the head is abnormal.... i am worried abt this.... can anyone pls help A quick search on http://www.ncbi.nlm.nih.gov/ for "dolichocephalic" finds this word in numerous medical research articles, some databases, and 3 online books. Many websites define "dolichocephalic", which simply means the head is long. It isn't clear what the CI= 67% refers to, but 67% normally would mean that the problem, if there is one, is minor. Is the head abnormal in some other way? Ask your doctor to explain exactly what measurements he is concerned about, and what he thinks it means. Your doctor may be thinking of this medical research article: | J Ultrasound Med. 1996 May;15(5):375-9. |Dolichocephaly and oligohydramnios in preterm premature rupture of the membranes. | * Levine D, | * Kilpatrick S, | * Damato N, | * Callen PW. |Department of Radiology, Beth Israel Hospital, Boston, Massachusetts 02215, USA. | |This study evaluates the association between dolichocephaly and fetal outcome after preterm premature |rupture of membranes. Dolichocephaly was more common in preterm fetuses in the breech presentation |than those in the cephalic presentation and was more common in fetuses with oligohydramnios of long |duration. Of fetuses in the cephalic presentation, 10 of 12 (83%) surviving dolichocephalic fetuses had |respiratory distress syndrome compared with 31 of 73 (42%) normocephalic fetuses. However, other |outcome parameters did not differ significantly. We conclude that the finding of dolichocephaly is |associated with oligohydramnios of long duration. In fetuses with preterm premature rupture of |membranes it is associated with respiratory distress syndrome, but not otherwise with a poor neonatal |prognosis. | |PMID: 8731444 The above is just the abstract of the article, not the complete article. You might want to get the complete article. Anyway, from this much information, if I were you I would focus on the oligohydramnios, because that is something you may be able to correct. Correcting it will help you avoid preterm premature rupture of membranes. Google this group for oligohydramnios and you'll find my own story re oligohydramnios. Hang in there! |
#3
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Dolichocephalic head
I think your doctor's priorities are misplaced. The oligohydramnios is
more worrisome than the dolicocephaly. Dolicocephaly, as noted above, simply describes a long, narrow head. The CI (cephalic index) is the ratio of width to length, so it is lower with dolicocephaly. 75-80 is considered normal. Rarely, extreme dolicocephaly can be associated with abnormal brain or bone development. 67 is not that extreme. I doubt that is what is going on here. Mild dolicocephaly is often associated with breech positioning and/or low amniotic fluid. In this case, the baby's head is being squeezed into a slightly different shape. That sounds alarming, but remember that babies' heads are meant to be flexible to facilitate the birth process. The Levine article quoted by Pologirl is liable to misunderstanding and the authors aren't helping much - what isn't very clear in their abstract is that the increased respiratory distress they noted in association with dolicocephaly is MUCH more likely due to the prolonged rupture of membranes and low fluid volume than they are due to the dolicocephaly itself. In other words, they are encouraging the reader to confuse cause and effect. Prolonged rupture of membranes with low fluid volume causes both dolicocephaly and newborn respiratory distress. As for the oligohydramnios, how worrisome this finding is depends on how low the fluid volume is, what the trend of the fluid volume is over time, and what is causing the low fluid volume. Sometimes mild oligo may be found when there is nothing else wrong and in this case it is unlikely to cause problems. If oligo is found in association with abnormal fetal heart rate tracings, fetal anatomic abnormalities, abnormal blood flow through the umbilical cord, or fetal growth restriction, then it is more concerning. Is your doctor sending you to a specialist to repeat the ultrasound and explain the findings to you? If he/she was hammering on the dolicocephaly and glossing over the oligohydramnios, then I think you need a more qualified person to address this aspect of your care. |
#4
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Dolichocephalic head
Anyway, from this much information, if I were you I would focus on the oligohydramnios, because that is something you may be able to correct. Correcting it will help you avoid preterm premature rupture of membranes. I think you're confusing cause and effect here also. Oligohydramnios does not cause PPPROM - rather PPPROM can be a cause of oligo. Most causes of oligohydramnios are not modifiable by the mother. Fetal renal anomalies, urinary tract anomalies, and most cases of abnormal placental perfusion are not caused by, nor can they be cured by, the mother changing her behavior. Exceptions are extreme dehydration and use/abuse of substances that alter placental blood flow. In these cases, maternal behavior changes may improve the amniotic fluid level. Sometimes, when amniotic fluid volume is low due to poor placental perfusion, mothers are asked to restrict their activity - the idea being that more oxygen will get to the fetus if the mother isn't "spending" oxygen on physical activity. Whether this recommendation actually does anything to change the fluid level or the newborn outcome is highly debatable. |
#5
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Dolichocephalic head
alath wrote, addressing me: I think you're confusing cause and effect here also. Oligohydramnios does not cause PPPROM - rather PPPROM can be a cause of oligo. Chronic oligohydramnios is highly correlated with premature labor, and to a lesser extent also with PPROM (not PPPROM), and the medical presumption is that oligohydramnios itself is a contributing factor to both. Most causes of oligohydramnios are not modifiable by the mother. True. On the other hand, in the minority of cases where it is modifiable, it is relatively easy to modify. Alath, I guess you did not read my posts here these last 6 months. I was diagnosed severe oligohydramnios at the start of the 3rd trimester of a pregnancy with a fetus known to have a problem that often causes oligohydramnios. My caregivers, who suspected the oligohydramnios was due to the fetal problem, searched very hard for causal connections but found none. Meanwhile, I did my own research in the medical literature. Some research articles report good results from increasing hydration of mothers who were otherwise normally dehydrated. I increased my consumption of water and improved my AF to low normal. Perhaps in my case the improvement was a coincidence; perhaps not. Bedrest is the conventional cure-all, but I gather that it does not help with oligohydramnios of unknown etiology. Anyhow, I think we both agree that the OP's least problem here is her baby's head shape. Of what she has mentioned, the greatest concern is the oligohydramnios. |
#6
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Dolichocephalic head
Chronic oligohydramnios is highly correlated with premature labor, and to a lesser extent also with PPROM (not PPPROM), and the Again, correlations do not necessarily indicate the direction of causality. medical presumption is that oligohydramnios itself is a contributing factor to both. Much more often it is the other way around: PPPROM leading to oligo and preterm labor. I am interested in the idea of oligo as a cause of spontaneous preterm labor. Can you cite a source please? |
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