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Does an ultrasound showing baby with lemon shaped head mean something is wrong?

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Practicing since : 1983
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i am 20weeks pregnant dr called me and said that the radialogist looked at my ultrasound and baby looks like it has a lemon shaped head and he is not ruling out neruo tubal defects. i have had both of the genetic blood tests done and they both came back negative. also that the spine on the ultrasound looked fine. being sent for a level 2 ultrasound but for now i would like to know if it could have been nothing or is that always a positive sign of something wrong?
Posted Thu, 26 Apr 2012 in Pregnancy
Answered by Dr. Minoo Bhagia 5 hours later
Hello ,

Thanks for putting up your query here.

Lemon shaped head means pointed forehead and inwardly drawn skull bones at the base. It can be associated with spina bifida or becomes normal in the third trimester.

To confirm spina bifida and other neural tube defects there must be other signs also like positive quadruple test.

As you have mentioned that your genetic tests are normal, I would like to know the name of the test and the values.
Quadruple test includes : Alpha-fetoproteins , unconjugated estriol , hCG and inhibin A.

Triple screen test or triple marker does not include inhibin A.

Quadruple test is more accurate than triple marker.

If any abnormality is detected then next step will be to perform an amniocentesis and repeat this test.

Remember there can be false positive or false negative results for any test. Hence we should choose the test step by step based on thier sensitivity and specificity accuracy.

Level two ultrasound along with positive test confirms the diagnosis of neural tube defects.

Abnormal values can be seen in case of miscalculation of the gestational age also. There can be slight variation in different labs also. Check these two out with your doctor first.

If the test is abnormal you talk to your genetic counselor. In your case having three normal children and considering only one sign , ' lemon shaped ' head does not always mean spina bifida.

Don't be anxious, wait for the next level tests.

Wishing you good luck. If you have any other queries left please let me know.
Best regards

Above answer was peer-reviewed by
Follow-up: Does an ultrasound showing baby with lemon shaped head mean something is wrong? 5 hours later
could it have just been a bad ultrasound reading? or there are never any mistakes in reading or taking ultra sound pictures?
Answered by Dr. Minoo Bhagia 1 hour later

Welcome again.

No you can not say that it was a '' bad ultrasound reading''.

Ultrasound definitely shows ' lemon shaped head ' which indicates so many things, neural tube defect is one of them but only one tool can not make a definite diagnosis.

Regarding mistakes while taking ultrasound pictures, the chances are very less but yes the reading definitely needs two opinions.

Spina bifida can be occulta type also which is not a serious condition at all.

If your level two ultrasound does not show a spot on the back and there is no banana or lemon sign then you should think twice before going for amniocentesis as chances of miscarriage though very less but are still there.

Hope this answers your query.

Best regards.

Above answer was peer-reviewed by
Follow-up: Does an ultrasound showing baby with lemon shaped head mean something is wrong? 9 hours later
i just had the afp screening test dont have the amounts or any thing the doctor just said they were normal. i guess i will have to just wait and see what the level 2 ultrasound says. if theres nothing on the spine what does that mean?
Answered by Dr. Minoo Bhagia 7 hours later

Thanks again.

I am very happy for you as your alpha fetoproteins are normal. You are less likely to have spina bifida or any other neurological defect.

'' Nothing on the spine'' means the spine is normal and they don't find any defect on it.

Wishing you all the best.

Take care
Above answer was peer-reviewed by
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