Every attempt should be made to visualize both cerebellar hemispheres to allow a comparison of their size and echotexture. Dolichocephaly, variant of normal. The face is a large and complex structure. Solid arrow, medulla oblongata; open arrow, pons; asterisk, cisterna magna; c, cerebellum. ICD 10 code for Maternal care for other (suspected) fetal abnormality and damage, not applicable or unspecified. It should be remembered that the anterior pillars of the fornices lie in the same general area as the CSP. Fusion of all sutures produces a tall pointed skull known as acro- or oxy-cephaly. The bladder should be visible in all cases from 12 weeks onward. In addition to measuring the BPD and HC, the occipitofrontal diameter (OFD) can be measured and expressed in ratio to the BPD (BPD/OFD) as the cephalic index (CI) (Fig. However, fetal position, reduction in amniotic fluid volume, and increased bony ossification often make the third trimester examination more challenging. This scan can be done anytime between 18-22 weeks of your pregnancy but ideally around the 20 week mark. It is commonly, though not exclusively, a result of an extended stay in neonatal intensive care unit (NICU). 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. 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. /Length 9 0 R Dolichocephaly With BPD 5%: In my 20 week scan I was told below There is a single intra-uterine viable foetus with no morphological abnormality detected. The number of fingers is relatively easy to assess in the first trimester as all fingers, including the thumb, lie in approximately the same ultrasound plane (Fig. Appointment Center 24/7 216.445.7050. Cephalic index: a gestational age-dependent biometric parameter. 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. The paired laminar ossification centers are slightly offset from the midline. These are due to subarachnoid trabeculae and represent a normal finding.103105. /Creator ( w k h t m l t o p d f 0 . 1.29). It is normally small (<3 mm diameter) and may be difficult to visualize. Antonyms for dolichocephaly. B: Axial view in a plane slightly caudal to A, where the cavum septi pellucidi (solid arrow) and cavum septi vergae (open arrow) are seen as two separate structures. Thank you, {{form.email}}, for signing up. Blickman JG, Parker BR, Barnes PD. Often the mean value is taken ~78 (range 74-83 3). Calipers, transcerebellar diameter; cp, cerebral peduncles; t, thalami; open arrow, insula; asterisk, cavum septi pellucidi; chevron, falx cerebri. What are synonyms for dolichocephaly? Using axial planes, the mid-second trimester cerebellum is seen as a dumbbell-shaped structure consisting of two hemispheres connected by the vermis. Obstet Gynecol. 2008;27:503515. 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. At 20 weeks gestation, the upper limit of normal is considered to be 10 mm, although recently some authors have suggested that even measurements up to 12 mm are very unlikely to be associated with significant pathology.8790 The ventricles become less prominent with advancing gestation although a threshold of measurement <10 mm is typically also used in the third trimester. Dolichocephaly is a long keel-shaped skull with prominent forehead and occiput. 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. This involves evaluation of the vertebrae and the contents of the spinal canal. Dolichocephaly is a mild cranial deformity in which the head has become disproportionately long and narrow, due to mechanical forces associated with breech positioning in utero. A Diagnosis of Microcephaly refers to some babies having a small head when measured by ultrasound during pregnancy, and with a tape measure around the head after birth. Scaphocephaly, results from premature closure of the sagittal suture, so that lateral growth of the skull is prevented whilst anteroposterior growth continues, producing a narrow and elongated cranium. Willis S, Hsiao R, Holland RA, Lee K, Pitetti K. Measuring for nonsynostotic head deformities in preterm infants during NICU management: A pilot study. Is this a problem? Dolichocephaly is a mild cranial deformity in which the head has become disproportionately long and narrow, due to mechanical forces associated with breech positioning in utero. 137 (1): 83-5. The most common defects are a cephalocele or an encephalocele. At this point, the CRL is defined as measurement between the top of the fetal head and the fetal rump along its longitudinal axis (Fig. Healthcare providers use ultrasound exams for several purposes, including during pregnancy, for diagnosing conditions and for image guidance during certain procedures. FIGURE 1.7: Transverse views of a fetal head at 12 weeks gestation demonstrating hindbrain appearance at various levels in descending order. Note the formation of a cyst-like structure in B. Calipers, cisterna magna measurement; c, cerebellar hemispheres. An abnormal skull shape can also lead to difficulties with chewing, swallowing, vision, and breathing. /Filter /FlateDecode h, head. Cranial vault asymmetry (CVA): also referred to as diagonal difference, oblique diagonal difference, or transcranial difference. /Type /XObject It is best assessed in the midsagittal section. 1.39). Dolichocephaly is a term used to describe a tall, narrow head. Solid arrow, fourth ventricle; open arrow, cisterna magna; c, cerebellum. Paciente femenina de 48 aos de edad con historia de hipertension arterial. C: Section demonstrating vertebral arch ossification centers (solid arrows) only. Arrow, fourth ventricle; c, cerebellum. 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. 1.42). Q[4Rj^N'GEq]? Psychological problems such as poor self-esteem and depression can also occur as the child gets older. According to the American Academy of Pediatrics (AAP), misshapen heads and skull deformities occur about 20% of the time during childbirth or as a result of a babys position in the womb. Ultrasound findings are frequently best interpreted in combination with quantitative maternal serum hCG (human chorionic gonadotropin) with or without progesterone levels. Sometimes casually referred to as "NICUcephaly," some cases of dolichocephaly affect premature babies who have spent some time in the NICU. At the time the article was last revised Munyi Ambrose Ithiga had 1.1).47 This finding is considered normal until the early portion 12th week of gestation and should not be mistaken for an omphalocele. FIGURE 1.28: Right parasagittal section of a fetus at 12 to 13 weeks gestation with color and pulsed Doppler. The cephalic index (CI) is a ratio/value calculated using two fetal biometric parameters which are the occipitofrontal diameter (OFD) and the biparietal diameter (BPD). FIGURE 1.15: Transverse view of the abdomen at 13 weeks gestation at the level of the abdominal circumference. 2017;57(5):21724. The posterior fossa anomalies are one area where a fetal MRI may be especially helpful in arriving at the correct diagnosis. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. 1.46). Dolichocephalic head shapes are relatively rare in cultures where infants sleep supine. Facts about Craniosynostosis. Absence of an ossified calvarium in association with abnormal intracranial anatomy is consistent with exencephaly/anencephaly sequence. A CI, which is below 0.74, connotes a relatively flat head (dolichocephaly), while a CI above 0.83 describes a relatively round head (brachycephaly).83 Dolichocephaly is not uncommon and is often seen in fetuses that are in a persistently breech presentation or in association with chronic oligohydramnios. 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. /ca 1.0 stream Increased BMI can significantly compromise the ultrasound examination and may require a change in the usual strategy. Both individual vertebrae and their skin covering should be evaluated by sliding the transducer along the entire length of the spine. The face, specifically lips and nose, are best examined in sagittal section (see Fig. v, lateral ventricles; solid arrow, ocular orbit with a lens within it; chevron, maxilla; open arrow, body of the mandible. no financial relationships to ineligible companies to disclose. In this rare case, surgery is very successful after birth to correct the problem. 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. Not infrequently, the cavum septi pellucidi et vergae (CSPV) contains septations, especially in its posterior portion (Fig. Z@N And will have appointment with my private Obstertric , he will do ultrasound to check head . Calipers, NT measurement; solid arrow, nasal bone; t, thalamus; bs, brain stem; f, fourth ventricle; open arrow, maxilla; chevron, upper lip. Using transvaginal ultrasound, the presence of an intrauterine gestational sac can be consistently demonstrated by the completion of the 5th week of gestation. By Wendy Wisner Are Head-Shaping Pillows Safe for Babies? The fetus is in a neutral position and occupies the majority of the image. A specialist must fit molding helmets. It represents a space between the two septi pellucidi, which is filled with cerebrospinal fluid (CSF). FIGURE 1.45: A transverse view of vertebrae at various levels of the vertebral column: cervical (A); thoracic (B); lumbar (C); sacral (D). All stated gestational ages are according to last menstrual period dating. Open arrow, vertebral body ossification center. 1.11). Note that this is a neonatal image to show the anatomy in its entirety. 7) The sacral portion of the spine usually has a more persistent curvature, with the tip of the spine pointing posteriorly (Fig. 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. For unknown reasons, the rate of survival is higher in females than in males, leading to a female predominance among live-born trisomy 18 infants. 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. In some cases, the dolichocephaly resolves by the time the baby goes home, but in other cases, it remains, and babies are discharged from the hospital with dolichocephaly. 1.2). Examination of the cerebral cortex focuses on ruling out any space occupying lesions, either cystic or solid in nature. On this page: Article: Epidemiology Pathology FIGURE 1.32: Midcoronal view of the brain at 24 weeks gestation. A grossly decreased cephalic index suggests dolichocephaly while a grossly increased one can suggest brachycephaly. "iM.1,O`jpW}&kG3k}-:(Ht-%mV(uJ]J5/qBS(w$|a>=*>3aPtP4(Ey=:tS{FB[@}XtVu/Zj0LMD6iBQ~eg- b28|0@WY6>!Q*D&;&\C4jK)wlrgGDu+^QR'[nV=MC@ C6?jFBE[T-lQ @-9,~\(?KMq9_pJ^(3EGR6S/^+rv7y~ Note the two juxtaposed pillars of the fornix (open arrow) with a midline echogenic division. It can change according to various situations such as Cortical maturation continues throughout pregnancy, as the brain develops gyri and loses its smooth appearance (Fig. 1.7). It is seen as a hypoechoic structure between the cerebral peduncles and the cerebellum (Fig. Routine examination of the intracranial anatomy should always include identification of these structures. Dolichocephaly. 1.30 to 1.33). Fetal feet can also be identified, though evaluating the number of toes may be difficult because of their small size (Fig. It can change according to various situations such as, The usual range is variable depending on various sources and different demographic groups. 3. . Marley Hall is a writer and fact-checker who is certified in clinical and translational research. Fused sutures are identifiable by their absence, because they're invisible once fused, or by the ridging of the suture line. The atrium is located medially. Some mild cases of dolichocephaly and other instances of misshapen skulls will not require treatment, as they will generally just resolve as your baby grows. CVA is the difference between 2 diagonal measurements (frontozygomaticus to opposite eurion). The sagittal suture usually begins closing later in life, at around 2130 years of age. In humans, the anterior-posterior diameter (length) of the dolichocephaly head is more than the transverse diameter (width). Verywell Family's content is for informational and educational purposes only. /Title ( D o l i c h o c e p h a l y , v a r i a n t o f n o r m a l . To see microcephaly during pregnancy, the ultrasound test should be done late in the 2nd trimester or early in the third trimester. 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. /Height 60 These include organizations such as the American College of Obstetricians and Gynecologists (ACOG), American Institute of Ultrasound in Medicine (AIUM), Australasian Society of Ultrasound in Medicine (ASUM), National Health Service (NHS) in the United Kingdom, and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) (Table 1.3).37 Guidelines typically describe the essential components of an obstetric ultrasound examination. Compare with Figure 1.7. bs, brainstem; asterisks, cerebellar hemispheres; arrow, cisterna magna. While there are several types of craniosynostosis, sagittal synostosis is most commonly linked to dolichocephaly. When three or more of these characteristics are present, 1 point is added to the systemic score. 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. Dolichocephaly - understanding 'breech head' molding | The midwife, the mother and the breech 31/07/2015 19:13 Notched arrow, falx cerebri. 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. These diagnoses can be difficult to tease out and depend on findings in axial, midsagittal, and coronal sections. 1.21 and 1.22). J Ultrasound Med. They are hypoechoic and have a generally rectangular shape in the axial plane. /CreationDate (D:20180611143312+03'00') Con transductor linear de 7,5 Mhz se visualiza imagen nodular con eco-patrn mixto ( contenido solido-liquido ), se localiza en lbulo derecho . Has anyone experienced this, this early. However, a lack of proportionality be-tween the head circumference and the biparietal diameter is more obvious to spot (e.g. In an axial section at the superior aspect of the thorax, clavicles can be seen even early in gestation (Fig. Additional fetal biometry is performed if clinically appropriate. The calvarium should be systematically examined to ensure that it is intact. The hepatic artery peak systolic velocity may be evaluated in the same section to aid in aneuploidy risk assessment (Fig. Dolichocephaly has been reported in fetuses with sagittal synostosis. In the axial section, the contour of the fetal head is normally oval in shape. As such, it needs to be examined at multiple levels and in multiple planes.110, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Biochemical Screening for Neural Tube Defect and Aneuploidy Detection, Fundamental and Advanced Fetal Imaging Ultrasound and MRI. Head ultrasound was normal except marked dolicocephaly, head circumference between -1 and -2 SD, and suspected delay of sulcation. Ideally, the surgery takes place in the early months of life for optimal results. The inferior (temporal) horns run through the area of the temporal lobe and are difficult to identify unless they are enlarged. Note the relatively prominent adrenal glands (a), which need to be kept in mind in order not to mistake them for the kidneys. The case was diagnosed to be a variant of Miller-Dieker syndrome (MDS). Images Scaphocephaly: The head has a short laterolateral and a long anteroposterior diameter. Causes. Microcephaly, a diagnosis that is seldom confirmed postnatally . ASSESSING FETAL ANATOMY DURING THE SECOND AND THIRD TRIMESTERS. The shape of the ventricles is best assessed using the combination of longitudinal and coronal views (Figs. The fetal echocardiogra showed an increase in postvalvular flow and altered pulmonary venous return. National Council on Radiation Protection and Measurements. The occipital horns project posteriorly. facial appearance (dolichocephaly, malar hypoplasia, enophthalmos, retrognathia, down-slanting palpebral fissures) Involvement: at least 2 major criteria or 1 major and 2 minor Ocular Major ectopia lentis Minor abnormally flat cornea (as measured by keratometry) increased axial length of the globe (as measured by ultrasound) Download Sagittal Craniosynostosis: A Guide for Parents and Caregivers. The vertebral column should be evaluated in at least two of the three planes: coronal, axial, and longitudinal (midsagittal). However, these are often better seen in a coronal section of the face (Fig. The shape of the skull may be abnormal in association with a number of specific fetal anomalies. FIGURE 1.26: Upper extremity at 12 to 13 weeks gestation. FIGURE 1.41: Axial view of a fetal head in the third trimester after the completion of insular operculization. The BPD is assessed using an axial image of the head at a level where standard anatomic landmarks are visible: The globular and slightly hypoechoic paired structures representing the thalami in the midportion of the head with a slit-like hypoechoic structure representing the third ventricle located between them, the cavum septi pellucidi (CSP) in front of the thalami, and the lateral ventricles, with the frontal horns seen anteriorly and the atria (trigones) seen posteriorly. The sagittal section offers the best view of the fetal forehead. Appointments & Locations. A pediatric physical therapist can be helpful as you navigate your journey with dolichocephaly. Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography. In babies with craniosynostosis, the brain stops growing in the part of the skull that has closed too quickly, while other parts of the brain continue growing. During surgery, the affected suture is removed to correct the baby's head shape. Craniosynostosis Babies' skull bones contain spaces in between them that are filled with a flexible substance called sutures. The approach to the anatomical survey is essentially the same in both the second and the third trimesters. Please note the difference in anatomic detail between the proximal and distal half of the brain. It is best to develop a systematic approach to the examination. FIGURE 1.17: Transverse view of the abdomen at 13 weeks gestation at the level of abdominal cord insertion (arrow). http://carta.anthropogeny.org/moca/topics/age-closure-fontanelles-sutures. 1 synonym for dolichocephaly: dolichocephalism. /SM 0.02 FIGURE 1.4: Sagittal view of an 11- to 12-week fetus. It is measured with the cursor placed on the outer edge to the outer edge of the cranial bone. 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. Mosby Inc. (2009) ISBN:0323031250. ADVERTISEMENT: Supporters see fewer/no ads. 1 2 . When a craniosynostosis is suspected, the first line imaging will be ultrasound or x-rays, depending on local expertise and preferences. Babies' skull bones contain spaces in between them that are filled with a flexible substance called sutures. The transvaginal approach should be used in all circumstances where a viable intrauterine pregnancy is not obvious on transabdominal assessment. It first appears as a heterogeneous depression, which is increased in echogenicity. White arrows, trigones; asterisks, choroid plexi; black arrows, section through a portion of the cerebellum. Returning to an axial section, the anterior abdominal wall and cord insertion are evaluated (Fig. What is Dolichocephalic? The embryonic stage, ending at 10 weeks gestation, is a time of very rapid change in the small, developing conceptus.45 Ultrasound before 11 weeks gestation is not typically regarded as a routine part of pregnancy assessment. The abnormal shape of the skull can also result in difficulties to chew and swallow, as well as issues with vision and breathing. In the axial section, the three ossification centers are in a triangular arrangement. Dolichocephaly is diagnosed when the skull has a cephalic index less than 75 on the scale. Dolichocephaly most commonly occurs in preterm infants in the NICU: so-called NICUcephaly. When a babys head is misshapen: Positional skull deformities. 1.23). At the time the article was last revised Daniel J Bell had no recorded disclosures. Some critically ill infants may be positioned supine with the head. A Morphology scan is a recommended ultrasound examination of your pregnancy at 19-20 weeks gestation. Exposure Criteria for Medical Ultrasound, II: Criteria Based on All Known Mechanisms. Unable to process the form. The hemispheres develop gyri through the third trimester, which are visible on ultrasound, and the cerebellar tonsils become more elongated. FIGURE 1.5: Sagittal view of a 12- to 13-week fetus. << Neuroimaging and molecular cytogenetics were used to ascertain the cause of disability in a case. 1.10). 1.50). A 20-week ultrasound, sometimes called an anatomy scan or anomaly scan, is a prenatal ultrasound performed between 18 and 22 weeks of pregnancy. endobj 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. /SMask /None>> You may have fears about the future, and you may not know how to handle what is happening in the here and now. B: Arrow, open communication with cisterna magna; f, fourth ventricle. Please note the increased echogenicity of the roof of the third ventricle extending into the foramina of Monro. Virchow correlated head shape with the fusion of specific sutures and introduced some definitions that are still in general usage such as dolichocephaly for sagittal synostosis, trigonocephaly for metopic synostosis, and plagiocephaly for unilateral coronal synostosis. FIGURE 1.39: Parasagittal section of the fetal head with the temporal lobe (t) visible. (2012) American Journal of Roentgenology. (2005) ISBN:1588901475. 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. 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. The tech noted dolichocephaly, yet everything else is normal. Assessment of the central nervous system is not complete without detailed examination of the fetal spine. FIGURE 1.48: Sagittal view of the cervical spinal cord (notched arrow) in late second trimester. 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. 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. When an embryonic pole becomes identifiable, the best method of establishing the gestational age is measurement of the crown-rump length (CRL). Often, the region of interest can be effectively identified using grayscale prior to employing Doppler, resulting in reduced energy exposure to the fetus. FIGURE 1.47: Sagittal view of the spine in mid-second trimester demonstrating its normal curvature. FIGURE 1.24: Fetal foot (arrow) with all five toes visible (12 to 13 weeks gestation). FIGURE 1.30: Sagittal view of the lateral ventricle at 24 weeks gestation. Prominent pulsations can be seen at the bottom of the depression, which represents the Sylvian segment of the middle cerebral artery (Fig. Note the difference in echogenicities between the various organs. ADVERTISEMENT: Supporters see fewer/no ads. cp, choroid plexus; arrow, third ventricle. In addition to the bifrontal scalloping of the cranium described earlier, open spine defects are accompanied by the Chiari Type II malformation (herniation of the cerebellar tonsils through the foramen magnum and downward displacement of the cerebellar vermis). FIGURE 1.44: A, B: Suboccipitobregmatic views of the head demonstrating a variety of normal septations within the cisterna magna (cm). h, fetal head. 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. Anyone had this and how did it turn out? In cases of isolated brachycephaly and dolichocephaly, our findings of a normal outcome in 80% of these cases confirm that these isolated features are rarely associated with a fetal abnormality. 4,f~Z]\1aHZ9Lx40!?-v*oTf+*i;/F@l#C5b[4I.uf B,\ux+~G39EzF^}gsR8v.jnS$6p-,b$1F3{o V W'4C8)3j|jO 7w&p5=Rj [BD,11X1vHd+/H3$S)`"A 1@"2FIcD]9Rt52D[ 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. This dolichocephalic preterm infant enjoys time in the upright seated position, promoting midline positioning and head reshaping. NRCP report 140. From Fowlkes JB; Bioeffects Committee of the American Institute of Ultrasound in Medicine. FIGURE 1.8: Transverse views of a fetal head at 13.5 weeks gestation demonstrating progressive development of the cerebellum. FIGURE 1.23: Fetal hand with all phalangeal ossification centers visible (13 to 14 weeks gestation). Another axial section routinely employed to evaluate the intracranial anatomy is the suboccipitobregmatic view: Starting with the BPD view, the posterior aspect of the probe is rotated caudally until the posterior fossa becomes visible. The routine calculation of CI can be performed at antenatal scanning, and a value outside the normal range, or a . In contrast to other craniosynostoses, there is near normal IQ and no hydrocephalus. 1.29). 2. /BitsPerComponent 8 /Type /XObject This chapter deals with normal fetal anatomy; however, frequent references to anomalies are made to underscore the pertinence of a good anatomic evaluation. . 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. These positions are used to protect premature babies' healthincluding decreasing their risk of reflux, apnea, and bradycardiabut unfortunately can result in dolichocephaly. D4?n*uU5[ \lGi'X!fS+yUCDKu\e T\DO[bTq2FiTPiePL \GC?h3s$t_*pWiKBi\$3WGbln 1.48). /AIS false Coronal sections add very little information to the axial ones, but depending on the position of the fetus, this approach may provide the clearest view. The spinal cord can be delineated within the spinal canal using ultrasound on most exams (Fig.