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

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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!

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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.

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> 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.

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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.

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> 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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