Favourable outcome of a tight constriction band secondary to amniotic band syndrome

Abstract

Amniotic band syndrome or amniotic disruption complex is a well-known congenital limb abnormality, which occurs in 1 in 1200 to 1 in 15,000 live births. In cases of an isolated band constriction, it has been speculated that the bands lead to decreased blood flow in the constricted limb and subsequent natural amputation. Fetal surgery could be considered in these situations in order to release the constriction band in threatened limb amputation. We present a case of a tight constriction ring secondary to amniotic band syndrome with a favourable outcome, despite the failure of an attempted surgical procedure.

Perinatal outcome after fetoscopic release of amniotic bands: a single‐center experience and review of the literature

“…Surgery was impossible in one case due to persistent intra-amniotic bleeding, and in this case there was membrane separation 24 hours after the surgery 3 . In two other cases uterine wall and intra-amniotic bleeding led to removal of the second port (which was being used for the fetoscope).…”

“…Interestingly, when PPROM did occur in cases of ABS, it was at a median of 4 weeks after the procedure, which is in contrast to other fetal intervention procedures in which PPROM usually occurs within the first 2 weeks 13 . Whether membrane rupture is a direct complication of the fetoscopic procedure or is related to the intrinsic membrane properties in patients with ABS is unclear 3 . Clearly, in these cases there is potential for more movement of the trocar and endoscope than in FETO or laser surgeries because of the nature of the pathology.…”

“…The underlying causative factors and the pathophysiology of amniotic bands remain unclear. Membrane rupture, either spontaneous or iatrogenic, appears to account for the majority of cases but congenital anomalies of the amniotic membranes have also been implicated 3 . Regardless of etiology, there is increasing experience with intrauterine release of congenital constrictions and evidence is mounting that this therapy may help save/restore some limb function and morphology 4 .…”

Morphometry of Umbilical Cord and Its Relation With Umbilical Arteries- A Foetal Study

“…18 Its pathogenesis includes prior rupture of membranes or early disruption of otherwise normal membranes. 19 One case of amniotic band in thigh was noted in the present study (0.9%).…”

Instrumental requirements for minimal invasive fetal surgery

“…52 The first clinical attempts for in utero release of amniotic bands were described by Quintero et al, 53 and since then several reports have been published. 54,55 It may be quite difficult to identify and release the membrane constriction deep within edematic tissue. The instruments required are, next to a fetoscope, adapted sheaths and laser energy, but that may cause collateral damage.…”