Amniotic Band Syndrome, Perinatal Hospice, and Palliative Care versus Active Management

Abstract

Introduction. Amniotic band syndrome and sequence are a relatively rare condition in which congenital anomalies occur as a result of the adherence and entrapment of fetal parts with coarse fibrous bands of the amniotic membrane. A large percentage of reported cases have an atypical gestational history. The frequency of this obstetric complication is not affected by fetal gender, genetic abnormality, or prenatal infection. Case. A 21-year-old, G1P0 female parturient at 18 weeks and 5 days with a single intrauterine gestation during a routine ultrasound evaluation was noted to have amniotic band sequence. The pregnancy was subsequently complicated by preterm premature rupture of membranes with oligohydramnios, resulting in a surviving neonate scheduled for rehabilitative treatment. Conclusion. Amniotic band syndrome is an uncommon congenital anomaly resulting in multiple disfiguring and disabling manifestations. Several theories are proposed with most involving early rupture of the amnion and entanglement of fetal parts by amniotic bands. This syndrome can be manifested by development of multiple malformations, with the majority of the defects being limb abnormalities of a disorganized nature, as in the case we present. In the absence of a clear etiology of consequential congenital abnormalities, obstetric management guidelines should use shared decision models to focus on the quality of life for the offspring.

Amniotic band syndrome associated with malformation of extremities

“…The other possible etiological factors for the syndrome are primiparous mother of under 25 years of age 2 , unplanned pregnancy 3 , direct abdominal trauma 1,2 , induced 1 or unsuccessful abortion, 2 intrauterine contraception 2 , amniocentesis 1,2 , malformations of the uterus 2 , cerclage 6 maternal exposure to drugs such as ergotamine, misoprostol 2 and non-steroidal anti-inflammatory drugs 3 , bacterial infection of the amniotic membranes 1 , oligohydramnios's 2 hyperthermia 3 and prematurity 6 . According to literature, considerable amount of cases were related with PPROM 12,13 .…”

Picture in a Picture

“…Amniotic bands are now being successfully released fetoscopically through minimally invasive surgery. Extrauterine surgical intervention should be performed within weeks to months [5].…”

Amniotic Band Syndrome: A Silent Knife In-Utero

“…Majority of the cases are reported within the background of atypical gestational history. 12 Two theories have been proposed: intrinsic and extrinsic hypothesis. The intrinsic or endogenous theory by Streeter (1930) explains the origin of the fibrous bands and anomalies as a consequence of a perturbation of developing the germinal disc of the early embryo.…”