doi:10.2176/nmc.ra.2017-0006. However, a lack of proportionality be-tween the head circumference and the biparietal diameter is more obvious to spot (e.g. What Does It Mean to Have a Frank Breech Baby? The genital tubercle (open arrow) up from the fetal longitudinal axis (>30). Color Doppler is used to demonstrate the renal arteries (solid arrows) in A, which can become nondetectable with only a slight adjustment of the transducer, as in B. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. This is a normal variant and is part of the leptomeningeal space between the roof of the third ventricle and the body of the fornices. Use in cases of unusual head shape. Both hands are commonly held in front of the chest or fetal face, and the legs are generally flexed at the hip at this gestation. 1.29). Alternatively, an apparently increased antero-posterior length of the head compared to width. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. In the anteroposterior axis, the spine is curved, being convex in the thoracic region and concave in the lumbosacral region. Unilateral or bilateral CPCs are a common finding affecting 1% to 4% of euploid fetuses but have also been associated with aneuploidy, particularly trisomy 18. Overcurvature of the thoracic spine, kyphosis, or lateral curvature of the spine, scoliosis, can be detected by careful assessment of at least two of the three standard planes. It is commonly, though not exclusively, a result of an extended stay in neonatal intensive care unit (NICU). Arrow, fourth ventricle; c, cerebellum. Early fusing of the joints (sutures) between the bony plates that form an infant's skull keeps the brain . Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Most examinations at this stage are performed for a specific clinical indication such as pain or vaginal bleeding associated with a positive pregnancy test. Her work has been published in medical journals in the field of surgery, and she has received numerous awards for publication in education. It can also be helpful to get in touch with other parents who have been through similar experiences through an online or in-person support group. Head ultrasound was normal except marked dolicocephaly, head circumference between -1 and -2 SD, and suspected delay of sulcation. In the mid-second trimester, bifrontal scalloping occurs in >95% of open neural tube defects resulting in a lemon-shaped calvarium seen in the axial section.84,85 The occipital portion of the skull is typically flattened in trisomy 18, while the frontal and parietal portions of the skull gently slope toward one another anteriorly, creating a strawberry shape in axial view. /Filter /FlateDecode Regardless of the approach used, the fetus needs to be assessed in all planes: Longitudinal, axial, and coronal. Note that CVA will be symmetric in symmetric brachy-, and dolichocephaly. A: Arrow, developing aqueduct of Sylvius; bs, brain stem. Dolichocephaly has two primary causes: craniosynostosis or positioning. Craniosynostosis is a birth defect in which the bones of the baby's skull fuse together prematurely before the brain has fully developed. A cloverleaf shape of the skull is more specific of various fetal abnormalities including Pfeiffer syndrome 23, 24. Note the relatively prominent adrenal glands (a), which need to be kept in mind in order not to mistake them for the kidneys. In addition to treatments from specialists, there are practices you can adopt at home to help your babys skull reach an optimal shape. We evaluated dolichocephaly, the name associated with a nonsynostotic cause to be a physiological variant having no prognostic value, to that of a similar synostotic or secondary to a. So worried 1.21 and 1.22). It is calculated as: cephalic index (CI) = biparietal diameter (BPD) / occipitofrontal diameter (OFD) x 100 The cephalic index gives an idea of the fetal head shape. Open arrow, vertebral body ossification center; solid arrow, vertebral arch ossification center. 19, 20) can help differentiate closed from open sutures [22]. Chevron, falx cerebri; cp, cerebral peduncles. A skeletal survey is best performed by utilizing both axial and transverse sections. Its common for babies heads to look slightly misshapen after birth and even in the first few weeks that follow. Mosby Inc. (2009) ISBN:0323031250. Microcephaly usually is the result of a problem with brain development, which can occur in the womb (congenital) or during infancy. If it appears to be exceptionally large, it can be objectively assessed by measurement of its anteroposterior diameter in an axial section of the posterior fossa (Fig. zW1}>P As the transducer is moved caudally, the orbits can be identified. These positions are used to protect premature babies' healthincluding decreasing their risk of reflux, apnea, and bradycardiabut unfortunately can result in dolichocephaly. ic d-li-k-s-fa-lik : having a relatively long head with cephalic index of less than 75 dolichocephaly d-li-k-se-f-l noun Word History Etymology New Latin dolichocephalus long-headed, from Greek dolichos long + -kephalos, from kephal head more at cephalic First Known Use Facts about Craniosynostosis. Exposure Criteria for Medical Ultrasound, II: Criteria Based on All Known Mechanisms. In this section, the intracranial anatomy essentially consists of the lateral ventricles and a very thin layer of brain parenchyma. In these conditions, the skull is also easily compressible, which can be demonstrated by applying gentle pressure with the ultrasound transducer. The accuracy of CRL measurement decreases with gestational age. ADVERTISEMENT: Supporters see fewer/no ads. FIGURE 1.27: Transverse/oblique section of the lower abdomen and the pelvis showing the urinary bladder (b) with two umbilical arteries coursing around it in a 12- to 13-week fetus. FIGURE 1.46: Coronal views of the vertebral column. However, the presence of multiple vertebral ossification centers does obscure it to a variable degree, especially later in gestation. 1.29). If the baby's head circumference is much smaller than the average head circumference for their age group or the week of pregnancy, he/she is said to have microcephaly. According to the AAP, there are three main interventions for misshapen skulls and positions skull deformities: physical therapy, helmet therapy, and surgery. Using this method, the accuracy of sex determination is only 70% at 11 weeks gestation but increases to nearly 100% at 13 to 14 weeks gestation.59. Open arrow, pulmonary artery; solid arrow, aorta; chevron, superior vena cava. At the time the article was created Yuranga Weerakkody had no recorded disclosures. The inferior (temporal) horns run through the area of the temporal lobe and are difficult to identify unless they are enlarged. 1.45).106,107 In the presence of an open spine defect, this arrangement is disrupted, and the laminar ossification centers are displaced laterally, forming the shape of the letter U or V in the axial view of the spine. Absence of an ossified calvarium in association with abnormal intracranial anatomy is consistent with exencephaly/anencephaly sequence. Note the differences in their appearance depending on the level. Confirm that the fetal heart is beating. This is because of the fact that they are the easiest to obtain and are very familiar to operators who are involved in fetal scanning. During this time frame, the fetus reaches a size and stage of development sufficient to allow for the performance of an informative anatomic survey.10,11,53 A number of markers, the most important of which is the nuchal translucency measurement, can be employed to provide an accurate risk assessment for aneuploidy. White arrows, trigones; asterisks, choroid plexi; black arrows, section through a portion of the cerebellum. FIGURE 1.12: Transverse view of the chest at 12 to 13 weeks gestation containing a four-chamber heart view. An embryonic pole with a heartbeat is generally detected by the middle of the 7th gestational week (MSD of approximately 18 mm). The transvaginal approach should be used in all circumstances where a viable intrauterine pregnancy is not obvious on transabdominal assessment. Increased BMI can significantly compromise the ultrasound examination and may require a change in the usual strategy. It has an incidence of 1 in every 4,200 babies." - Does this mean it ex Continue Reading More answers below Is ABVS ultrasound better at detecting abnormal tissues in breasts than conventional ultrasound? Thieme Medical Publishers. stream B: Arrow, open communication with cisterna magna; f, fourth ventricle. One reasonable approach to evaluating a fetus in an obese patient is to perform a thorough examination at 12 weeks gestation using the transvaginal route and delay the anomaly scan until 22 to 24 weeks gestation to increase the likelihood of successfully completing the structural examination. The lateral ventricles are essentially filled by choroid plexi, which are seen as paired echogenic structures, one within each hemisphere (butterfly view). Biparietal diameter of the head is . And will have appointment with my private Obstertric , he will do ultrasound to check head . FIGURE 1.36: A: Sagittal section of a fetal head at 22 weeks gestation with a cavum veli interpositi (notched arrow) located posteriorly and inferiorly to CSPV (asterisk). They are hypoechoic and have a generally rectangular shape in the axial plane. Dolichocephaly seems a Materials and methods Ultrasound examinations were performed prospectively at the Department of Obstetrics and Gynecology and at the Department of Medical Genetics and Fetal Medicine at Palack University Teaching Hospital in Olomouc. Dolichocephaly is a term used to describe a tall, narrow head. The whole length of the vertebral column can be seen in both a coronal and in a sagittal section, and the ossification centers should be spaced evenly in these views. FIGURE 1.8: Transverse views of a fetal head at 13.5 weeks gestation demonstrating progressive development of the cerebellum. Kyutoku S, Inagaki T. Review of past reports and current concepts of surgical management for craniosynostosis. A small angle, which is essentially parallel to the longitudinal axis of the fetus, indicates a female gender, whereas an angle measuring 30 or more suggests a male gender (Figs. A grossly decreased cephalic index suggests dolichocephaly while a grossly increased one can suggest brachycephaly. It provides the same information as the early first trimester scan with a number of additional benefits. FIGURE 1.9: Midcoronal view of the head at 12 to 13 weeks gestation. FIGURE 1.24: Fetal foot (arrow) with all five toes visible (12 to 13 weeks gestation). /Producer ( Q t 4 . ADVERTISEMENT: Supporters see fewer/no ads. The approach to the anatomical survey is essentially the same in both the second and the third trimesters. 7 0 obj If thats the case for you, you may have a lot of questions about this condition, what it means for your baby, and what treatment options are available. 3. Although these 2 terms have been used interchangeably by many, dolichocephaly refers to an elongated head without associated biparietal narrowing and is caused by positioning. Wendy Wisner is a lactation consultant and writer covering maternal/child health, parenting, general health and wellness, and mental health. Why Do Babies Have More Bones Than Adults? The fetal head and upper torso occupy the majority of the image, and the fetus is in a neutral position. It may be associated with craniosynostosis of the sagittal suture; it may be commonly seen in the premature infant and is more frequently a normal variant. All stated gestational ages are according to last menstrual period dating. Each image used in this chapter was obtained using two-dimensional (2D) ultrasound. Sometimes casually referred to as "NICUcephaly," some cases of dolichocephaly affect premature babies who have spent some time in the NICU. Microcephaly, a diagnosis that is seldom confirmed postnatally . Serial examinations may be needed to reach a diagnosis. /Height 60 Read our, Caring for the Soft Spots on Your Baby's Head. Scaphocephaly accounts for approximately 50% of all cases of craniosynostosisand has a male predilection with an M:F ratio of 3:1. 1.46). ; C]pb Craniosynostosis Babies' skull bones contain spaces in between them that are filled with a flexible substance called sutures. The uterus should then be scanned in cross section, from left to right and from top to bottom, determining the number of fetuses that are present and defining the lie of the fetus. An axial view of the inferior aspect of the cerebellum at this point in pregnancy may reveal a fluid-filled space between the tonsils, which may lead to the erroneous diagnosis of a defect in the vermis. Scaphocephaly (also known as dolichocephaly) is the most common form of craniosynostosis, where premature closure of the sagittal sutureresults in an impediment to the lateral growth of the skull while anteroposterior growth continues, producing a classic elongated, yet narrow, skull. Understanding Vaginal Tears During Labor and Delivery. 137 (1): 83-5. Cranial ultrasound imaging may be used. >> D4?n*uU5[ \lGi'X!fS+yUCDKu\e T\DO[bTq2FiTPiePL \GC?h3s$t_*pWiKBi\$3WGbln Synonyms for dolichocephaly in Free Thesaurus. Neuroimaging and molecular cytogenetics were used to ascertain the cause of disability in a case. The uterus and adjacent structures should be assessed in both longitudinal and axial sections, taking care to pass completely from side to side and from fundus to cervix to determine the number and location of gestational sacs and embryos. Biparietal diameter is used to estimate fetal weight and gestational age. An abnormal skull shape can also lead to difficulties with chewing, swallowing, vision, and breathing. While some research suggests genetic factors are linked to craniosynostosis-related dolichocephaly specifically, the true etiology of the condition is not yet fully understood. 22 week US baby head was oval and stated possible dolichocephaly&nbsp; but needed repeat scan at 24 weeks. This is because babies heads are meant to be moldable to accommodate the many changes that happen during gestation, birth, and the first year of life. s^Xmj{4BM+o2Lo_Y0 It is bounded by the corpus callosum anteriorly and superiorly, the fornix posteriorly, and the anterior commissure inferiorly. 1.24). 1.3).48 Whereas some investigators advocate using the average of three CRL measurements to establish gestational age, most use the single best measurement. A: Section through the cavum septum pellucidi et vergae at a point when continuity between two is evident (arrow). Although high-quality 3D rendered images of the fetal face are impressive to pregnant women, the use of 3D ultrasound does not reduce maternal anxiety [24]. Calipers, BPD measurement; chevron, lateral ventricle (occipital horn); open arrow, lateral ventricle (atrium containing echogenic choroid plexus); thin solid arrows, lateral ventricle (frontal horns); notched arrow, lateral ventricle (occipital horn); thick solid arrow, third ventricle; t, thalamus; asterisk, cavum septi pellucidi. 1.10). The posterior fossa anomalies are one area where a fetal MRI may be especially helpful in arriving at the correct diagnosis. Are Head-Shaping Pillows Safe for Babies? Physical exam, ultrasound: Treatment: Bracing, casting, surgery: Prognosis: Good (if detected early) Frequency: 1 in 1,000 (term babies) Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. This dolichocephalic preterm infant enjoys time in the upright seated position, promoting midline positioning and head reshaping. Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses sound waves to produce images of structures within your body. Since the corpus callosum is a structure that completes its formation relatively late in pregnancy, the CSPV should not be expected to be visible prior to 18 to 19 weeks gestation. Head length is measured between the glabella (the most prominent point on the . After 11 weeks gestation, the calvarium should be ossified and is seen as an echogenic ring around the intracranial structures (see Fig. Abnormal curvature may be due to the presence of a hemivertebra, which is a feature of a number of genetic syndromes such as VACTERL; therefore, other anomalies known to be associated with this syndrome should be actively sought. It can change according to various situations such as, The usual range is variable depending on various sources and different demographic groups. In more serious cases, surgery will be required. Pediatric radiology, the requisites. Scaphocephaly(also known as dolichocephaly) is the most common form of craniosynostosis, where premature closure of the sagittal suture results in an impediment to the lateral growth of the skull while anteroposterior growth continues, producing a classic elongated, yet narrow, skull. FIGURE 1.21: Sagittal view of a 12- to 13-week fetus demonstrating the presence of a small urinary bladder (solid arrow). 1.34). Since the cerebellar vermis is not yet fused, a large midline communication is seen between the developing fourth ventricle and the cisterna magna (CM) (Fig. In utero death occurs in more than 95% of fetuses with this chromosome anomaly. Duke University. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code O35.8XX0. Dolichocephaly has been reported in fetuses with sagittal synostosis. s, stomach; L, liver; arrow, portal sinus. When three or more of these characteristics are present, 1 point is added to the systemic score. Additionally, the bodies of the lateral ventricle and their continuation, the frontal horns, are domed in shape in the sagittal section; therefore, their appearance differs significantly when viewed in various axial planes. 1.47). /Length 7 0 R Wendy Wisner is a lactation consultant and writer covering maternal/child health, parenting, general health and wellness, and mental health. She has worked with breastfeeding parents for over a decade, and is a mom to two boys. /Width 38 1 2 . Solid arrow, medulla oblongata; open arrow, pons; asterisk, cisterna magna; c, cerebellum. /SA true At the time the article was created Frank Gaillard had no recorded disclosures. The shape of the skull may be abnormal in association with a number of specific fetal anomalies. As the spine is curved, it is common to be able to visualize the vertebral bodies at some levels and the arches at other levels in the same view (Fig. Sometimes it is called dolichocephaly, as 'dolicho' means long. FIGURE 1.20: Coronal view of the abdomen at the level of the kidneys (open arrows) in a 12- to 13-week fetus. endobj 1.43). With the exception of the above-described Chiari Type II malformation, most defects affecting the posterior fossa are cystic in nature (DandyWalker malformation, Blakes pouch, arachnoid cysts, and dysgenesis of the cerebellar vermis). If you are concerned that your baby may have a severe case of dolichocephaly that may result in any developmental, health, or psychological issues, you should speak to your pediatrician. Dolichocephalic head shapes are relatively rare in cultures where infants sleep supine. At this point, the pregnant uterus is out of the pelvis and is located well within the maternal abdomen. 3. Trong nhng trng hp nh vy, u hp v di ra. Fetal anatomy is best assessed at 20 to 24 weeks gestation. The spinal cord can be delineated within the spinal canal using ultrasound on most exams (Fig. Isolated enlargement of the fourth ventricle is unlikely to occur and is of limited clinical significance. However, many experts in the field advocate the use of additional views to improve diagnostic performance. 8 . The atrium is located medially. This ratio is valuable in describing the shape of the head. This is something your doctor will discuss with you, as the need for these interventions is case-by-case. In the axial section, the three ossification centers are in a triangular arrangement. 1 FIGURE 1.41: Axial view of a fetal head in the third trimester after the completion of insular operculization. Abnormalities such as frontal bossing, which are part of a number of skeletal dysplasias or a sloping forehead present in conditions such as microcephaly, are best visualized in this fashion. The cephalic index is the scale to measure the size of the baby's head. In the axial section, the contour of the fetal head is normally oval in shape. endobj It needs to be kept in mind that the shape of the lateral ventricle is 3D complex; unless it is enlarged, it is difficult to visualize in its entirety in a single ultrasound plane. 1. dolichocephaly is associated with dozens of developmental disabilities that can result in mental retardation. cp, choroid plexus; thick solid arrow, frontal horn; open arrow, body of the lateral ventricle; chevron, trigone; thin solid arrow, portion of the occipital horn; notched arrow, inferior (temporal) horn. It checks on the physical development of the fetus and can detect certain congenital disorders as well as major anatomical abnormalities. The sagittal suture usually begins closing later in life, at around 2130 years of age. Note that this is a neonatal image to show the anatomy in its entirety. th, temporal horn; solid arrow, color Doppler of the middle cerebral artery; open arrow, Sylvian fissure; csp, cavum septi pellucidi. Images can often be improved by rotating the probe so the brain is imaged through the suture lines and fontanelles, using techniques similar to those applied during neonatal examination. In addition to describing the basic components of an obstetrical ultrasound examination in this chapter, we also present extended views that improve the quality of the examination and the detection of pregnancy-related problems. In axial section at the level of the thalami, the atrium can be measured. Description Premature fusion of coronal and sagittal sutures usually leads to a tall, tower-like skull which is known as turricephaly. The normal range for CI is 0.74 to 0.83. FIGURE 1.39: Parasagittal section of the fetal head with the temporal lobe (t) visible. . FIGURE 1.3: Sagittal view of an 8-week gestation. The vertebral column should be evaluated in at least two of the three planes: coronal, axial, and longitudinal (midsagittal). (2011) ISBN:1609139437. C: Arrow, cisterna magna. This involves evaluation of the vertebrae and the contents of the spinal canal. Dolichocephaly refers to an elongation of an infants head caused most often by positioning after birth. In the coronal view, the two lateral points of ossification can be visualized cleanly, and by moving the probe anteriorly, ossification of the vertebral body can be brought into view. In longitudinal section, the line of ossification of vertebral bodies is seen anteriorly and, if there is a slight oblique cut, one set of posterior ossification sites will be visualized. However, fetal position, reduction in amniotic fluid volume, and increased bony ossification often make the third trimester examination more challenging. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Bell D, Zivic L, et al. Since the vermis is not fully developed until mid-gestation, vermian defects, especially small ones, are difficult to diagnose prior to 18 to 20 weeks gestation. The importance of positively identifying the CSPV lies in the fact that it can be absent in association with midline defects. 1.5). The index is calculated from measurement of the diameters of the skull. The length of the skull is the distance from the glabella (the midpoint between the brows) and the most projecting point at the back of the head. The paired laminar ossification centers are slightly offset from the midline. Both axial and coronal views are often required in order to identify them with confidence (Figs. Routine examination of the posterior fossa is critical to detect not only anomalies that originate in the posterior fossa but also changes that are indicative of problems in the spine. /Length 9 0 R As adjectives the difference between brachycephalic and dolichocephalic is that brachycephalic is (of a person or animal) having a head that is short from front to back (relative to its width from left to right) while dolichocephalic is (of a person or animal) having a head that is long from front to back (relative to its width from left to right). /Width 38 B,&uT>|Z'%,B!yZ~ayZpStTON"vl4sEJ{"=9#/j4UM. A finding that is commonly seen in the early first trimester and that deserves special mention is physiologic herniation of the midgut into the root of the abdominal cord insertion (Fig. Fetal feet can also be identified, though evaluating the number of toes may be difficult because of their small size (Fig. 1.4).49,50. Paciente femenina de 48 aos de edad con historia de hipertension arterial. Dolichocephalic definition: having a head much longer than it is broad , esp one with a cephalic index under 75 | Meaning, pronunciation, translations and examples Some critically ill infants may be positioned supine with the head. Cranial vault asymmetry (CVA): also referred to as diagonal difference, oblique diagonal difference, or transcranial difference. American Institute of Ultrasound in Medicine consensus report on potential bioeffects of diagnostic ultrasound. 1.50). endobj Note the sacral upswing (notched arrow). Centers for Disease Control and Prevention. This is often recommended when a babys head does not reach a healthy shape by the time they are 5 to 6 months old. 1.42). Examination of the CSPV in the sagittal section will help to elucidate the diagnosis (see Fig. One of the roles of a pediatric cardiologist who suspects or diagnoses a genetically determined connective tissue disease (e.g., Marfan, Ehlers-Danlos, and Loeys-Dietz syndromes) is to assess whether the aortic root is dilated. It is obtained by multiplying the maximum width of the head by 100 and dividing that number by the entire length of the head. The choroid plexus does not extend into the anterior horn of the lateral ventricle; therefore, cystic structures seen anterior to the caudothalamic notch will have a different underlying etiology. Often, the region of interest can be effectively identified using grayscale prior to employing Doppler, resulting in reduced energy exposure to the fetus. The hemispheres develop gyri through the third trimester, which are visible on ultrasound, and the cerebellar tonsils become more elongated. Surgery in infancy can improve head shape and prevent psychological issues that can stem from a severe cosmetic concern. Check for errors and try again. Blickman JG, Parker BR, Barnes PD. When a craniosynostosis is suspected, the first line imaging will be ultrasound or x-rays, depending on local expertise and preferences. It should be remembered that the anterior pillars of the fornices lie in the same general area as the CSP. 1.12 to 1.14). 1.40). FIGURE 1.26: Upper extremity at 12 to 13 weeks gestation. Psychological problems such as poor self-esteem and depression can also occur as the child gets older. A@h%F( *>`%1* nc13l>{|Yww=~ q2v7 `OKq2xP[rp2"%#0uTF ;WS+' << When found in isolation, risk for aneuploidy is not increased, but it is worth reviewing the results of first trimester screening, and in particular of first trimester biochemistry (both free -hCG (beta human chorionic gonadotropin) and PAPP-A (pregnancy-associated plasma protein A) are low in trisomy 18), to check there are no common themes through different modalities of screening. 20w scan - Dolichocephalic head shape. Use to discriminate between a normal fetal head shape and a head that is abnormal enough to alter the estimation of the fetal age based on the BPD. FIGURE 1.43: A: Axial section of a fetal head in the mid-second trimester weeks demonstrating the fourth ventricle (arrow). . Even though this view is primarily designed to evaluate the posterior fossa and the back of the fetal head, it also offers a good view of the CSP, thalami, and the midbrain as well as their anatomic relationship (Fig. When using Doppler during the 11 to 13+6 week scan, power indices should be reduced to a minimum, and the region of interest should be interrogated for the minimum time necessary. Anterior cerebral (open arrow) and pericallosal (solid arrow) arteries with some of their branches are demonstrated using color Doppler. The half of the brain that is closest to the transducer is much more difficult to image clearly when compared with the distal half. The conus medullaris can be identified as the place where the spinal cord comes to its end point (Fig. Gestational age is 20 weeks, 1 day, with EDD of 09/01/2023 by the clinical dates given. Note that this is a neonatal image to show the anatomy in its entirety. Scaphocephaly. The genital tubercle (open arrow) points in a direction parallel to the longitudinal axis of the fetus, indicating a female gender. A cystic midline structure that is occasionally seen located posteriorly and inferiorly to the CSV is the cavum veli interpositi (Fig. 1.38). My 20 week ultrasound also recvealed abnormal head dimensions and cephalic index of 69. If one or more sutures close early, it will cause the skull to expand in the direction of the sutures that remain open, which can result in an abnormal head shape. Dolichocephaly - understanding 'breech head' molding | The midwife, the mother and the breech 31/07/2015 19:13 In cases of moderate or severe skull deformity, therapies and other interventions may be necessary. Prenatally ultrasound can reveal clinical features of arthrogryposis multiplex congenita/fetal akinesia . But what happens if your babys head is more severely misshapen? Dolichocephaly is diagnosed when the skull has a cephalic index less than 75 on the scale. Calipers, CRL measurement; d, diencephalon; m, mesencephalon; r, rhombencephalon.