Abnormal first-trimester fetal nuchal translucency and amniotic band syndrome

Two case reports: Early detection of amniotic band syndrome by adhesion between hand and umbilical cord at 11 to 14 weeks' gestation

RATIONALE

The significant ultrasonic characteristics of amniotic band syndrome (ABS) are the malformations of fetal affected parts and the band-like echoes in amniotic cavity. This article first suggests that the fetal hand adhered to umbilical cord with restricted movement provides some values in the diagnosis of ABS in early gestational weeks especially when the fetal malformation is not obvious and amniotic band is thin and fine.

PATIENT CONCERNS

Two pregnant women had no discomfort and underwent routine ultrasound examination at 11 to 14 gestational weeks.

DIAGNOSIS

Only the fetal hand adhered to umbilical cord with restricted movement was detected during the first ultrasound examination at 11∼14 gestational weeks, and the floating band-like echos were detected in the amniotic cavity with follow-up examinations 2 to 3 weeks later. Both of the 2 fetus were diagnosed as ABS by ultrasound INTERVENTIONS:: The two pregnant women underwent the prenatal counseling and were recommended closely follow-up and further examination.

OUTCOMES

Two fetuses died in utero between 17 and 19 weeks. After induction of labor, it was found that the hands and umbilical cord of the fetuses were wrapped by amniotic bands, which was proved pathologically as ABS.

LESSONS

The adhesion of the fetal hand and umbilical cord is an important ultrasonic sign suggesting ABS with poor prognosis in early pregnancy. We hope that this study can provide some guidance for the early diagnosis of ABS during 11 to 14 week's ultrasound examination.

Early second-trimester diagnosis of body stalk anomaly by fetal magnetic resonance imaging

We report a case of body stalk anomaly detected prenatally by fetal magnetic resonance imaging (MRI) at 14 weeks' gestation. A 29-year-old woman was followed during her first pregnancy. At 11-12 weeks' gestation, our sonographic images showed multiple fetal deformities. An abdominal wall defect was suspected. The exteriorized abdominal contents and the lower limb appeared within the extraembryonic celom with an intact amniotic membrane. Fetal MRI at 14 weeks' gestation confirmed a large anterior wall defect with herniation of the liver and bowel. In addition, abnormally rotated lower limb and scoliosis could be demonstrated. The fetus was prenatally diagnosed with body stalk anomaly, expected to be lethal in nature. The parents decided to terminate the pregnancy at 15 weeks' gestation. Prenatal diagnosis of body stalk anomaly is usually based on sonographic findings. As far as we are aware, this is the first case report of body stalk anomaly satisfactorily diagnosed by fetal MRI in the early second trimester. Fetal MRI scans should provide ground for a precise antenatal diagnosis of body stalk anomaly from early gestation.