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Oligohydramnios, dolicocephaly and elevated AFPFrom: Jim Wang (jimwangmd@yahoo.com)Wed Jun 22 15:46:26 2005
A 33 year-old Chinese woman G1P0 was noted to have oligohydramnios and dolicocephaly on her 18-week ultrasound. Maternal serum AFP drawn at 18 weeks was subsequently found to be elevated (3.6). Pregnancy was complicated early on by slowly rising BHCG. PMH only remarkable for hyperthyroidism status post radioactive iodine ablation and now on thyroid hormone replacement. No family history of birth defects or miscarriages. Appreciate any comments on: 1. Any association between oligohydramnios, dolicocephaly and elevated AFP? Can oligohydramnios alone cause dolicocephaly and elevated AFP? Or are these separate problems? 2. What is the added risk of amniocentesis in the setting of oligohydramnios? Does the cumulative risk of the procedure exceeds the probability of finding spina bifida or chromosomal abnormality by amniocentesis? 3. Elevated AFP- is there any added utility of doing amniocentesis if the head, spine and stomach appear normal on US? Yes, there may be a small spina bifida that is not apparent on US. But if we can see leg movements on US and all other findings are normal, I am not sure any results from amniocentesis will sway us to intervene. 4. Dolicocephaly at 18-weeks gestation- sign of chromosomal abnormality? US at 13-weeks gestation did not show dolicocephaly. Could oligohydramnios be the cause? Thank you.
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