Doppler Flow Velocimetry Assisted Diagnosis of an Intrauterine Synechia During Pregnancy

Abstract

The differential diagnosis of reflective intrauterine membranes during pregnancy includes amniotic bands of fetal origin or membranes of combined maternal-fetal origin. While the former have been associated with fetal transverse reduction defects or the lethal amniotic band syndrome, the latter are usually benign and consist of a preexisting uterine septation or synechia around which the fetal membranes fold or become enveloped. We present an unusual case in which a patient was noted at 19 weeks' gestation to have an intrauterine membrane of undetermined origin, appearing to contain a pulsating vessel. Color Doppler imaging and Doppler flow velocimetry clearly depicted a pulse synchronous with the maternal heart rate, defining the membrane as amniotic membranes surrounding a preexisting uterine synechia and not a true amniotic band. The pregnancy was otherwise uneventful and the patient delivered a healthy neonate at elective repeat cesarean at which time the presence of the uterine synechia was confirmed.

Antenatal 3‐D sonographic features of uterine synechia

“…The size of its orifice was 47 mm. 3‐D sonography could illustrate the synechia in its entirety, 6 and color Doppler with the maternal heart rate was consistent with this cause 8 . In the present case, the size of the orifice of uterine synechia was 21.8 mm, and 3‐D sonography clearly showed umbilical cord prolapse through an oblique transverse uterine synechia.…”

Gray scale and color Doppler US findings of amniotic sheets

“…Some authors claimed that color Doppler US imaging with spectral analysis has an important role in the differential diagnosis of intrauterine membranes of undetermined origin during pregnancy (11,12). We also showed that b a all amniotic sheets that had an arterial flow revealed a maternal heart rate, indicating the maternal origin of these benign structures; however, five of ten sheets showed only venous flows.…”

“…Previous publications regarding Doppler analysis of the amniotic sheets were case reports (11,12), thus making this the first original article on Doppler analysis of the amniotic sheets in a series of patients. Some authors claimed that color Doppler US imaging with spectral analysis has an important role in the differential diagnosis of intrauterine membranes of undetermined origin during pregnancy (11,12).…”

Effect of an Amniotic Sheet on Pregnancy Outcomes

“…Subsequent studies revealed a thin maternal myometrial layer on pathologic examinations of sheets 12 , 13 . Doppler studies have also revealed arterial blood flow concurrent with maternal arterial blood flow on amniotic sheets 14 , 15 . In their recent study, Özkavukcu and Haliloğlu 8 reported maternal arterial blood flow, maternal venous blood flow, and no blood flow in 40%, 50%, and 10% of amniotic sheets, respectively.…”

“…Uterine interventions may have an important role in the etiology of an amniotic sheet 2 , 3 , 6 . Pathologic reports 12 , 13 and Doppler findings 14 , 15 have indicated a maternal origin of an amniotic sheet. In general, amniotic sheet formation is thought to occur as a result of folding of the extensions of the amnion and chorion over uterine synechiae 5 – 7 , 10 , 11 …”