Plagiocephaly

Plagiocephaly is 'a malformation of the head marked by an oblique slant to the main axis of the skull'. This condition is characterized by an asymmetrical distortion or flattening of one side of the skull. Positional or deformational plagiocephaly is known as 'flattened head syndrome' and this results from a preferential lying on one side of the head. Plagiocephaly is also common at birth, resulting from a restrictive intrauterine. The unusual head shape in plagiocephaly is caused by the pressure in the womb giving a diamond shaped head when observed from above. In some pronounced cases of plagiocephaly, there may occur flattening of one side of the chest as well.

Some other factors that increase the risk of plagiocephaly are multiple birth pregnancy where there is the risk of the babies squashing together in the womb. Prematurity, poor muscle tone and the Oligohydramnios condition with insufficient fluid in the womb to cushion the baby and torticollis or wryneck are other risk factors involved. In fact, nearly 15 to 25% of plagiocephalic children have torticollis. Frequent use of car seats, bouncy seats, infant swings are other contributory lifestyle factors to a baby where the back of head is flat.

Common symptoms of plagiocephaly or flat head syndrome include bald spot on the flattened side of an asymmetrical head, eyes appearing to have unequal positioning, flattening on one side of the back of the head with a compensatory bulge in the forehead on the same side, a parallelogram shaped head when viewed from above, where the back of the head is flat. Certain functional problems could occur at a later stage in life as a result of this deformity. These problems could involve vision, hearing, temporomandibular joint and developmental delay.

Treatment methodology advised by therapist to parents would include: to alternate the position or direction of the baby's head when sleeping, a tummy time of 15 minutes daily which will help take the pressure off the back of the skull, carrying the baby in a position that he/she can turn and look at both directions, dry the baby while the are on their tummy, allow infant to take supervised nap on the tummy for better head molding, avoid putting infants in a bouncy seat, car seat, sling or on a flat surface to dissuade constant pressure on one area of the skull.

However, it is imperative to distinguish between abnormal head shape caused by positioning and abnormal head shape caused by premature closure of cranial sutures, known as craniosynostosis. While positional deformation can be corrected without surgery, synostotic abnormal head shapes do require surgery. If left untreated, these children with moderate to severe plagiocephaly would experience other medical issues later in life.

High Risk Pregnancy

A woman's medical status, lifestyle or external factors may be the cause for high risk pregnancy. Some complications are unavoidable, while the risk in some others can be minimized by the help of the gynecologist / physician. Many times complications can also occur without any warning signal. Sometimes causes and risk factors can be identified early and suitably treated.

Anemia in pregnancy: Anemia occurs when the red blood cells are too few in the body. This leads to a lowered ability of the red blood cells to carry oxygen. Since the fetus is dependant on the mother's blood anemia can cause poor fetal growth, pre term birth and low birth weight. Anemia of pregnancy, iron deficiency anemia, vitamin B 12 deficiency, anemia due to blood loss, folate deficiency anemia are some of the types of anemia during pregnancy.

Pre term labor: In high risk pregnancies more than 11% of the babies born are pre term. Pre term labor begins before completion of thirty seven weeks of pregnancy. Pre term labor may mean either uterine contractions, rupture of amniotic sac and/or cervical dilatation. Many factors can contribute to pre term labor. Some of the key factors are:

• Maternal factors like preeclampsia, chronic medical illness, infection like urinary tract infections, vaginal infections, drug abuse, abnormal structure of the uterus, cervical incompetence, previous pre term birth.
  
  
• Factors involving pregnancy like abnormal or decreased function of the placenta, placenta previa and abruption, premature rupture of membranes
  
  
• Factors involving the fetus like behavior of intrauterine environment, multiple gestation and erythrobalstois fetalis which means Rh blood group incompatibility.
  
  

Intrauterine Growth Restriction (IUGR): This is a condition in which the fetus is smaller than expected for the number of weeks of pregnancy or there is fetal growth restriction. Newborn babies with IUGR are small for their gestational age. The baby's fetal weight is less than the 10th percentile. The fetus with IUGR may be born at term or prematurely. They appear thin, pale and have loose dry skin. Some have a wide eye look.

IUGR can begin at any time of pregnancy. While early onset of IUGR is due to chromosomal abnormality, late onset is due to other related problems. Although it is not possible to prevent IUGR, it can normally well managed by the doctor.

Generally the earlier and more severe the growth restriction, the greater the risk. Careful monitoring of the fetus growth is needed in all cases of IUGR. This is done by ultrasound and Doppler studies and mother's weight gain monitoring. Other ways to watch the potential high risk is by fetal movement counting, non stress testing, and biophysical profile examination.

Post term pregnancy: In contrast to pre term pregnancy, post term pregnancy lasts for more than forty two weeks. About 7% of babies are born at forty two weeks or later. Such post term pregnancies can cause longer hours of labor and operative delivery. Mothers are at increased risk for vaginal birth trauma due to large baby. Cesarean deliver is likely for post term babies.

Multiple pregnancy: Multiple pregnancy means two or more fetuses. A very small percentage (about 3%) of women experiences multiple pregnancy.

Post partum hemorrhage: This is when excessive bleeding follows the birth of the baby in the mother. About 4% of women have post partum hemorrhage. Immediate medical intervention is required to stop bleeding. Some women with placental abruption and placenta previa are more susceptible for post partum hemorrhage than others.

RH disease: This disease occurs when there is incompatibility between the blood of the mother and the baby. This again is a high risk factor in pregnancy.

Premature rupture of membranes: Premature rupture of membranes means breaking open of the membranes before labor begins, especially before thirty seven weeks of pregnancy. Nearly 10% of pregnancies suffer premature rupture of membranes.

Rupture or membranes is caused by natural weakening of membranes or from force of contractions. Low socioeconomic conditions, sexually transmitted infections, previous pre term birth, vaginal bleeding and cigarette smoking during pregnancy are some of the main causes for premature rupture of membranes. One third of the premature births suffer from premature rupture of membranes.

Gestational diabetes: Diabetes in pregnancy can have serious consequences for the mother and the fetus. The severity of the problem depends upon the degree of the mother's diabetic disease. In the US about 9 % if women have diabetes and one third of them do not know it. 2 to 3% of women develop diabetes during pregnancy called gestational diabetes. Here the mother who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy.

Tags: #Plagiocephaly #High Risk Pregnancy