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Waerlop F, Dehaene I, Roelens K. Successful management of fetal hypoxia due to amniotic banding at 26 weeks of pregnancy: A case report of a rare survival. Eur J Obstet Gynecol Reprod Biol 2024; 297:264-266. [PMID: 38616145 DOI: 10.1016/j.ejogrb.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Amniotic banding is a rare condition that can lead to structural limb anomalies, fetal distress and adverse obstetric outcomes. The main hypothesis for its etiology is a rupture of the amniotic membrane in early pregnancy, with the formation of tightly entangling strands around the fetus. These strands can constrict, incise, and subsequently amputate limb parts, the neck or head. More rarely, the amniotic banding can affect the umbilical cord, leading to fetal distress or potential intra-uterine fetal demise. OBJECTIVE We present a unique case of a 26-week pregnant woman who attended a polyclinical consultation due to reduced fetal movements with concerning cardiotocography (CTG) findings. A review of the literature about amniotic banding of the umbilical cord was conducted as well, identifying diagnostic and interventional options for the obstetrician's practice. STUDY DESIGN This is a case report, alongside a review of the literature. RESULTS The CTG indicated fetal distress, prompting an emergency caesarean section (C-section). Upon delivery, the neonate exhibited signs of amniotic band sequence, with distal phalangeal defects on the right hand and severe constriction of the umbilical cord caused by amniotic strands, the latter precipitating fetal hypoxia. Direct ultrasound diagnosis remains a challenge in the absence of limb amputation, yet indirect signs such as distal limb or umbilical doppler flow abnormalities and distal limb edema may be suggestive of amniotic banding. MRI is proposed as an adjuvant diagnostic tool yet does not present a higher detection rate compared to ultrasound. Fetoscopic surgery to perform lysis of the amniotic strands with favorable outcome has been described in literature. CONCLUSION This case presents the first reported survival of an extremely preterm fetus in hypoxic distress as a cause of amniotic banding of the umbilical cord, with a rare degree of incidental timing. Ultrasound diagnosis remains the gold standard. Obstetrical vigilance is warranted, with fetal rescue proven to be feasible.
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Affiliation(s)
- Florian Waerlop
- Ghent University (UGent), Ghent University Hospital (UZ Gent), Belgium.
| | - Isabelle Dehaene
- Ghent University (UGent), Ghent University Hospital (UZ Gent), Belgium
| | - Kristien Roelens
- Ghent University (UGent), Ghent University Hospital (UZ Gent), Belgium
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Nakashima M, Iizuka T, Kagami K, Yamazaki R, Ono M, Fujiwara H. Amniotic band syndrome in a monochorionic diamniotic twin pregnancy after rupture of the dividing membrane in the early second trimester: A case report. BMC Pregnancy Childbirth 2021; 21:456. [PMID: 34182926 PMCID: PMC8240361 DOI: 10.1186/s12884-021-03948-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amniotic band syndrome is a rare phenomenon, but it can result in serious complications. We report herein our experience of amniotic band syndrome in a monochorionic diamniotic twin pregnancy where rupture of the dividing membrane occurred early in the second trimester. CASE PRESENTATION A 29-year-old nulliparous woman was referred to us for management of her monochorionic diamniotic twin pregnancy at 10 weeks of gestation. When we were unable to identify a dividing membrane at 15 weeks of gestation using two-dimensional ultrasonography, we used three-dimensional ultrasonography to confirm its absence. Both modalities showed that the left arm of baby B was swollen and attached to a membranous structure originating from the placenta at 18 weeks of gestation. Tangled umbilical cords were noted on magnetic resonance imaging at 18 weeks of gestation. Emergency cesarean delivery was performed at 30 weeks of gestation because of the nonreassuring fetal status of baby A. The left arm of baby B had a constrictive ring with a skin defect. Both neonates had an uncomplicated postnatal course and were discharged around 2 months after delivery. CONCLUSIONS Attention should be paid to the potential for amniotic band syndrome if rupture of the dividing membrane between twins is noted during early gestation.
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Affiliation(s)
- Mizuki Nakashima
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takashi Iizuka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kyosuke Kagami
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Rena Yamazaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
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3
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Bailleul A, Athiel Y, Gueneuc A, Salomon L. Ultrasound findings in Pseudoamniotic band syndrome after fetoscopic surgery: Antenatal description of three cases and review of literature. J Gynecol Obstet Hum Reprod 2021; 50:102178. [PMID: 34107358 DOI: 10.1016/j.jogoh.2021.102178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pseudoamniotic Bands Syndrome (PABS) was described as iatrogenic complication from in utero procedure as fetoscopy. OBJECTIVE The aim of our study was to identify the ultrasound findings in PABS diagnosed prenatally METHODS: First, we reported cases of PABS following fetoscopic surgery that were diagnosed prenatally in our institution. We collected all ultrasound data with fetal and neonatal issues. Then, a literature review was conducted by searching the Medline and Cochrane Library computer databases until 2020 to find publications that involve PABS diagnosed prenatally or postnatally. The following keywords were selected and combined: "pseudoamniotic bands syndrome", "fetoscopy", "fetal surgery". RESULTS We collected three cases of PABS diagnosed prenatally in our center following fetoscopic procedures for complicated monochorionic pregnancies. Among these cases, we reported the following ultrasound findings: floating membrane, amniotic bands, striction of limbs, perilesional edema, reduced member size and anomalies of Doppler flow. Including our cases, we reported 23 published PABS of which eight (35%) were prenatally diagnosed. When it was diagnosed, mean GA at PABS diagnosis was 23 weeks (mean interval from fetoscopic to diagnosis was 4 weeks). Three fetoscopic release of amniotic bands were described. The principal parts affected were the limbs, more particularly the extremities. CONCLUSION PABS was accessible to an antenatal diagnosis, as well as ABS. Although it is a rare complication of fetoscopic surgery, ultrasound examinations after procedure should focus on PABS signs to improve prognosis of the neonates.
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Affiliation(s)
- Alexandre Bailleul
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Yoann Athiel
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Alexandra Gueneuc
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
| | - Laurent Salomon
- Fetal Medicine Unit, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; National Referral Centre for the Management of Complicated Monochorionic Pregnancies, Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
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4
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Minella C, Costantino B, Ruano R, Koch A, Weingertner AS, Favre R, Sananes N. Fetoscopic Release of Amniotic Band Syndrome: An Update. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1039-1048. [PMID: 32951245 DOI: 10.1002/jum.15480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
Amniotic band syndrome is a rare condition. There have been few cases reported of fetoscopic band dissection. The aim of this case series is to report 3 cases of fetoscopic treatment for amniotic band syndrome, including indication for surgery, technical aspects, complications and outcomes. Fetoscopic treatment was performed respectively at 23 5/7 , 26 5/7 and 18 3/7 weeks' gestation. Two procedures were performed with a laser fiber through a single trocar whereas one surgery was performed with scissors. In conclusion, fetoscopic release of the amniotic bands in case of amniotic band syndrome is feasible with encouraging results in order to prevent amputation and dysfunction of the extremities.
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Affiliation(s)
- Chris Minella
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | | | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Antoine Koch
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | | | - Romain Favre
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | - Nicolas Sananes
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
- INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie", Strasbourg University, France
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5
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Knijnenburg PJC, Slaghekke F, Tollenaar LSA, Gijtenbeek M, Haak MC, Middeldorp JM, Klumper FJCM, van Klink JMM, Oepkes D, Lopriore E. Prevalence, risk factors, and outcome of postprocedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome: a large single-center case series. Am J Obstet Gynecol 2020; 223:576.e1-576.e8. [PMID: 32335054 DOI: 10.1016/j.ajog.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/04/2020] [Accepted: 04/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postprocedural amniotic band disruption sequence is a condition that is associated with intrauterine interventions, and it is characterized by a constriction of the limbs or umbilical cord by fibrous strands, leading to edema, amputation, and/or fetal demise. OBJECTIVE To evaluate the prevalence of, risk factors for, and the outcome of postprocedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome cases. STUDY DESIGN All consecutive cases of twin-twin transfusion syndrome treated with fetoscopic laser coagulation of the vascular anastomoses at our center between January 2002 and March 2019 were included in the study. The occurrence of postprocedural amniotic band disruption sequence in these cases was recorded, and the potential risk factors were analyzed. RESULTS Postprocedural amniotic band disruption sequence was detected, at birth, in 2.2% (15/672) of twin-twin transfusion syndrome cases treated with fetoscopic laser surgery, in both the recipients (10/15, 67%) and the donors (5/15, 33%). Postprocedural amniotic band disruption sequence primarily affected the lower extremities (11/15, 73%) and, less frequently, the upper extremities (2/15, 13%), both the upper and lower extremities (1/15, 7%), or the umbilical cord (1/15, 7%). Postprocedural amniotic band disruption sequence led to the amputation of toes in 5 of 15 cases (33%) and resulted in fetal demise because of constriction of the umbilical cord in 1 case (7%). The independent risk factors identified for postprocedural amniotic band disruption sequence were lower gestational age at laser surgery (odds ratio per week, 1.43; 95% confidence interval, 1.12-1.79; P=.003) and the presence of postprocedural chorioamniotic membrane separation on antenatal ultrasound examination (odds ratio, 41.66; 95% confidence interval, 5.44-319.25; P<.001). CONCLUSION The prevalence of postprocedural amniotic band disruption sequence is low, but, when present, it may lead to severe consequences, with amputation of extremities or fetal demise occurring in more than one-third of the cases. Lower gestational age at the time of laser therapy and chorioamniotic membrane separation are independent risk factors for the postprocedural amniotic band disruption sequence.
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Affiliation(s)
- Patricia J C Knijnenburg
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Femke Slaghekke
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisanne S A Tollenaar
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna M Middeldorp
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Frans J C M Klumper
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanine M M van Klink
- Division of Child and Adolescent Psychology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dick Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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6
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Lafitte AS, Verspyck E, Jeanne Pasquier C, Dolley P, Dreyfus M, Benoist G. Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin-Twin Transfusion Syndrome: Two Case Reports and Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2373-2377. [PMID: 28736902 DOI: 10.1002/jum.14295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/06/2017] [Accepted: 03/11/2017] [Indexed: 06/07/2023]
Abstract
Pseudoamniotic band syndrome is a rare complication that occurs after invasive procedures for complicated monochorionic twins. We report 2 cases of intrauterine recipient fetal death after laser therapy for twin-twin transfusion syndrome due to umbilical cord constriction by the amniotic band.
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Affiliation(s)
- Anne Sophie Lafitte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
- Universitaire de Caen Normandie, Caen, France
| | - Eric Verspyck
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | - Patricia Dolley
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Michel Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
- Universitaire de Caen Normandie, Caen, France
| | - Guillaume Benoist
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
- Universitaire de Caen Normandie, Caen, France
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7
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Richter J, Wergeland H, DeKoninck P, De Catte L, Deprest JA. Fetoscopic release of an amniotic band with risk of amputation: case report and review of the literature. Fetal Diagn Ther 2012; 31:134-7. [PMID: 22248756 DOI: 10.1159/000335026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/10/2011] [Indexed: 11/19/2022]
Abstract
Amniotic bands can cause limb amputation as well as intrauterine fetal demise. Fetoscopic release of amniotic bands has been shown to rescue limb function. Herein, we describe an interesting case of an amniotic band wrapped around the right forearm as well as the umbilical cord, which was released by fetoscopy. Following the procedure, the blood flow in the forearm was restored and the edema gradually reduced. Full functionality of the arm was confirmed after birth, though the esthetic problem of the imprint of the band on the arm persisted. Furthermore, we review the available literature regarding fetoscopic interventions in amniotic band syndrome.
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Affiliation(s)
- Jute Richter
- Department of Obstetrics and Gynaecology, University Hospitals of Leuven, Leuven, Belgium
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8
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Rodrigues A, Araújo C, Carvalho R, Melo MA, Pinto L, da Graça LM. Limb Constriction Secondary to Pseudoamniotic Band Syndrome after Selective Fetoscopic Laser Surgery: Report of a Case with a Favorable Outcome. Fetal Diagn Ther 2012; 32:288-91. [DOI: 10.1159/000336666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 01/17/2012] [Indexed: 11/19/2022]
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9
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Rinker B, Vasconez HC. Constriction band syndrome occurring in the setting of in vitro fertilization and advanced maternal age. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 14:41-4. [PMID: 19554231 DOI: 10.1177/229255030601400104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The debate as to the pathogenesis of constriction band syndrome began with Hippocrates and continues today. The exogenous theory attributes the condition to entanglement of the fetus in the amniotic remnants following premature rupture of the amnion, which is in contrast to the endogenous, or genetic, mechanism.A case of constriction band syndrome in the setting of in vitro fertilization, where the child was genetically unrelated to the birth mother, is presented. Constriction band syndrome has been reported following amniocentesis and chorionic villus sampling, but it has not heretofore been presented in the setting of in vitro fertilization. In addition, the present case presents an opportunity to separate maternal from genetic factors and, possibly, shed some light on the etiology of the condition.
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Affiliation(s)
- Brian Rinker
- Division of Plastic Surgery, University of Kentucky, Lexington, Kentucky, USA
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10
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Cruz-Martinez R, Van Mieghem T, Lewi L, Eixarch E, Cobo T, Martinez JM, Deprest J, Gratacos E. Incidence and clinical implications of early inadvertent septostomy after laser therapy for twin-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:458-462. [PMID: 21433166 DOI: 10.1002/uog.8922] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the incidence and clinical outcome of inadvertent septostomy after fetoscopic laser therapy for twin-twin transfusion syndrome (TTTS) and, particularly, to explore its association with the risk of developing pseudoamniotic band syndrome (PABS). METHODS In a cohort of 414 consecutive monochorionic twin pregnancies with confirmed TTTS treated with laser, the incidence of postoperative septostomy within 1 week of the procedure was recorded prospectively. Rates of preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and PABS were compared among cases with and without septostomy. RESULTS The mean gestational age at laser therapy was 20.4 (range, 15.3-27.6) weeks. Postoperative septostomy occurred in 30 (7.2%) cases. Pregnancies complicated with septostomy had a significantly higher proportion of preterm delivery before 32 weeks (76.7% vs. 30.2%, P < 0.001), PPROM before 32 weeks (46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001), compared with pregnancies without septostomy. CONCLUSIONS Inadvertent septostomy occurred in 7% of cases after fetoscopic laser therapy and was associated with a substantially increased risk of adverse perinatal outcome and PABS.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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11
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Peiró JL, Carreras E, Soldado F, Sanchez-Duran MA, Aguirre M, Barber I, Martinez-Ibañez V. Fetoscopic release of umbilical cord amniotic band in a human fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:232-234. [PMID: 19173230 DOI: 10.1002/uog.6289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Umbilical cord amniotic bands occur in approximately 10% of cases of amniotic band syndrome and are a well-known cause of fetal death. An unexpected amniotic band encircling the umbilical cord was diagnosed during a fetoscopic procedure to release a leg constriction. Both bands were released fetoscopically using a YAG laser. We report the first case of an amniotic band involving the umbilical cord diagnosed and released prenatally.
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Affiliation(s)
- J L Peiró
- Department of Pediatric Surgery, Fetal Surgery Unit, Hospital Universitari Vall Hebron, Universitat Autònoma de Barcelona, Area Maternoinfantil, Barcelona, Spain
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13
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Winer N, Salomon LJ, Essaoui M, Nasr B, Bernard JP, Ville Y. Pseudoamniotic band syndrome: a rare complication of monochorionic twins with fetofetal transfusion syndrome treated by laser coagulation. Am J Obstet Gynecol 2008; 198:393.e1-5. [PMID: 18395033 DOI: 10.1016/j.ajog.2007.09.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 07/03/2007] [Accepted: 09/17/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the incidence and risk factors of limb constriction defects that are related to pseudoamniotic band syndrome (PABS) after selective fetoscopic laser surgery (FLS) in fetofetal transfusion syndrome (FFTS). STUDY DESIGN All consecutive cases of FFTS that were treated by selective FLS between 1999 and 2006 were examined prospectively for PABS at the time of delivery. Incidence and characteristics of PABS were reported. Univariate analysis was conducted to look for potential risk factors of developing PABS. RESULTS The 438 consecutive FFTS cases were treated at 15-26 weeks of gestation; PABS developed in 8 cases (1.8 %). The affected twin was always the former recipient. The diagnosis was made prenatally in 2 of 8 cases (25%). All cases survived the perinatal period. PABS affected fetal leg, arm, and foot in 3, 4, and 1 cases, respectively. In 5 (62.5%) and 7 (87.5%) cases, PABS occurred after premature rupture of membranes and intrauterine death of the donor, respectively. In 4 cases (50%), there was both premature rupture of membranes (PROM) and intrauterine fetal death; in 3 cases (37.5%), there was intrauterine fetal death alone, and in 1 case (12.5%), there was PROM alone. In the remaining 430 cases, PROM occurred in 62 cases (14.4%) and 66 cases (15.3%) within and after 3 weeks after surgery, respectively. PROM was significantly more frequent within the group that was complicated with PABS than within the rest of the cohort (P = .05). No maternal, fetal, or perioperative risk factor could be identified. CONCLUSION Awareness and targeted serial ultrasound evaluation in this high-risk group may improve prenatal diagnosis, counseling, and management of PABS after FLS.
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14
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Lurie S, Feinstein M, Mamet Y. Umbilical cord strangulation by an amniotic band resulting in a stillbirth. J Obstet Gynaecol Res 2008; 34:255-7. [DOI: 10.1111/j.1447-0756.2008.00765.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Ronderos-Dumit D, Briceño F, Navarro H, Sanchez N. Endoscopic Release of Limb Constriction Rings in utero. Fetal Diagn Ther 2006; 21:255-8. [PMID: 16601333 DOI: 10.1159/000091351] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 05/17/2005] [Indexed: 11/19/2022]
Abstract
Amniotic band syndrome is a sporadic condition that may result in constriction bands, amputation and multiple craniofacial, visceral and body wall defects. It occurs in 1/1,200 to 1/15,000 live births. Most cases present with multiple congenital anomalies that are incompatible with life. A small group of fetuses shows isolated limb constrictions that may cause severe limb dysfunction or limb amputation if left untreated. Successful in utero surgical lyses of constriction rings have been reported. We report a case of constriction amniotic bands involving both legs and compromising blood flow to the distal extremity. The constriction ring was successfully released by a minimally invasive endoscopic surgical technique avoiding severe limb dysfunction or foot amputation.
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Affiliation(s)
- D Ronderos-Dumit
- Diagnostico Prenatal, Clínica Materno-Infantil Farallones, Cali, Colombia.
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16
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Hadj Taieb H, Dhaoui MR, Bayouth I, Youssef S, Jaber K, Doss N. [Striction bands in a child]. Ann Dermatol Venereol 2006; 133:77-8. [PMID: 16495862 DOI: 10.1016/s0151-9638(06)70852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- H Hadj Taieb
- Service de Dermatologie, Hôpital Militaire Principal d'Instruction de Tunis.
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17
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Abstract
The development of fetal surgery has led to promising therapeutic options for a number of congenital malformations. However, preterm labor (PTL) and premature rupture of membranes continue to be ubiquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access surgical techniques were developed and are increasingly employed. Congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma have already been successfully treated using minimal access fetal surgical procedures. Other life-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. The wider application of minimal access fetal surgery depends on a continued improvement in technology and a better understanding of complications associated with fetal intervention.
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Affiliation(s)
- Enrico Danzer
- Division of Pediatric Surgery, Department of Surgery, The Fetal Treatment Center, University of California, San Francisco, CA, USA
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Devlieger R, Ardon H, Verbist L, Gratacós E, Pijnenborg R, Deprest JA. Increased polymorphonuclear infiltration and iatrogenic amniotic band after closure of fetoscopic access sites with a bioactive membrane in the rabbit at midgestation. Am J Obstet Gynecol 2003; 188:844-8. [PMID: 12634668 DOI: 10.1067/mob.2003.213] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the efficacy and safety of closing the fetoscopy access site in a midgestational rabbit model by using a commercially available bioactive membrane. STUDY DESIGN Fetoscopy was performed in a total of 100 gestational sacs in 20 does at midgestation (23 days, term = 31 days). In 50 cases (group 1), the fetoscopic access port was closed with a 5-mm patch of biocompatible matrix derived from porcine small intestine containing growth factors (transforming growth factor-beta and fibroblast growth factor-beta). Fifty sacs served as positive controls (group 2) and 55 unoperated fetuses were used as negative controls (group 3). At 30 days of gestation, a second-look laparotomy was performed. Outcome parameters were fetal weight, fetal lung weight, fetal lung-to-body weight ratio, and microscopy of the plugging site. RESULTS Membrane integrity after fetoscopy was restored in 28 of the 40 (70%) of cases in group 1 versus 13 of the 32 (41%) in group 2 (P =.012). Birth weights were comparable (group 1: 30.65 +/- 5.68 g; group 2: 29.70 +/- 5.05 g; group 3: 29.52 +/- 6.25 g; NS), but fetal lung weight (group 1: 0.964 +/- 0.20 g; group 2: 0.798 +/- 0.17 g; P <.01) and fetal lung-to-body weight ratio (group 1: 0.032 +/- 0.0067; group 2: 0.027 +/- 0.0082; P <.05) were significantly higher in the study group. In group 1, cellular proliferation was significantly increased. Polymorphonuclear infiltration was observed in 19 of the 40 (48%) cases in group 1 versus 5 of the 32 (16%) cases in group 2 (P <.05). In one treated sac, a fibrous band joining the two fetal legs without constriction was present. CONCLUSION The use of a bioactive membrane improved fetal membrane repair rates and decreased incidence of pulmonary hypoplasia in the rabbit but increased polymorphonuclear infiltration. In one amniotic sac, a situation comparable to amniotic band syndrome was documented.
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Affiliation(s)
- Roland Devlieger
- Centre for Surgical Technologies, Faculty of Medicine and Department of Obstetrics and Gynaecology, University Hospitals, K. U. Leuven, Belgium
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