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Newborn and Infant Care

Abnormally large head in ultrasound



My niece is 5 and a half months pregnant. She just went for her check up and they kept measuring and remeasuring saying the measurements weren`t adding up. The baby`s head was very large. I know she has used drugs in the past, and I fear she`s been using during pregnancy, but do not know for a fact. She goes for a follow up ultrasound in 4 weeks. What could this mean? Large head and short limbs? What are the possibilites? Thank you in advance for you help.


That must very scary news! Of course, it may be that large heads run in the family and that there is no problem. However, one of the most common causes of an exceptionally large head is congenital hydrocephalus (hi-dro-cef-a-lus). This falls in the family of neural tube defects which occur very early in gestation at about the third - fourth week of pregnancy. Their occurrence is influenced by maternal dietary deficiencies and genetics as well as occurring spontaneously without known influences.

The problem is one in which the fluid that cushions the brain and spinal cord inside the bony protection of the skull and vertebral column, or back bone, builds up within the brain and presses on the developing brain tissue limiting it's growth and function. Normally the fluid circulates freely between the brain and spinal column, but in hydrocephalus there is an obstruction that causes fluid build up in the brain. The most common treatment is to insert a shunt that drains the excess fluid from the brain into the child's abdomen. This is done soon after birth in order to protect the growing brain.

It would be best to wait and hear the results of the next ultrasound before getting too worried about what it might be. Your niece needs much positive support and encouragement at this time. Many, if not most, congenital defects are random and not the result of maternal behavior. Alarming her or blaming her would not be helpful now or after baby's birth should there be a problem. I am happy for her that she has a concerned and caring aunt to support her through the tough time of waiting.  


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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University