Laser therapy for twin-to-twin transfusion syndrome causing amniotic band syndrome

Karunaratne, S; Mukherjee, Samudra; Ramanan, R

doi:10.1136/adc.2010.193508

Cited by 7 publications

(5 citation statements)

References 2 publications

(1 reference statement)

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“…Even though we examined all babies and abortuses delivered in our hospital, this incidence could still be under-estimated, as we did not have the chance to examine babies who were delivered elsewhere. In the English literature, there were 25 cases of PABS reported previously [1,2,3,4,5,6,7], of which only 12 cases had clinical details. These 12 cases were reviewed together with our 3 cases (table 1).…”

Section: Discussionmentioning

confidence: 99%

Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review

Ting

Lao²,

Law³

et al. 2015

Fetal Diagn Ther

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Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication that arises after invasive procedures in monochorionic twins. We report 3 cases of PABS, 2 after fetoscopic laser photocoagulation and 1 after bipolar cord coagulation. Two cases were detected antenatally by ultrasound; out of the two, one underwent successful fetoscopic release of amniotic band, which is the first report in twin pregnancy to our knowledge. In our centre, the incidence of PABS was found to be 2%. There were 25 cases of PABS reported previously, of which 12 cases with clinical details were reviewed together with our 3 cases. The fetal limbs were involved in all 15 cases, leading to constriction or amputation. The umbilical cord was involved in 2 cases, resulting in fetal death in one and pregnancy termination in the other. Antenatal detection of PABS is rare (27%; 4/15) as this requires a high index of suspicion. Serial postoperative targeted ultrasound surveillance of the fetal limbs and umbilical cord is necessary, particularly when features of septostomy or chorioamniotic membrane separation are found. Colour Doppler examination for the perfusion of the affected limb should be performed when PABS is detected. Fetoscopic release of amniotic band could salvage the fetal limb from amputation when impaired blood flow is detected.

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Section: Discussionmentioning

confidence: 99%

Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review

Ting

Lao²,

Law³

et al. 2015

Fetal Diagn Ther

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“…We searched the literature for ABS following laser surgery in PubMed (searched on August 10, 2021), and identified 34 cases (Table 1). 4,24–32 All 34 cases showed TTTS. ABS after fetoscopic laser surgery for sIUGR has not yet been reported.…”

Section: Discussionmentioning

confidence: 97%

Disseminated intravascular coagulation complicated by amniotic band syndrome associated with deceased fetal umbilical cord following fetoscopic laser surgery

Ogoyama

Takahashi

Kagawa

et al. 2022

J of Obstet and Gynaecol

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Fetoscopic laser surgery occasionally causes amniotic band syndrome, in which the disrupted amniotic membrane constricts fetal body parts, leading to functional or morphological loss. We report a case of fetal distress at 31 weeks of gestation in the larger surviving twin after fetoscopic laser surgery for selective intrauterine growth restriction, necessitating emergent cesarean section. Physical examination of the infant showed constriction rings caused by a disrupted amniotic membrane on the digits, and the distal part of the right index finger was necrotic because of tight strangulation by an amniotic band with the umbilical cord of the deceased smaller twin. Laboratory data showed severe coagulopathy, and the infant was diagnosed with disseminated intravascular coagulation (DIC). Immediate treatment improved his condition. DIC may have been associated with the necrotic finger, which was strangulated by the umbilical cord of the deceased fetus, because neither maternal coagulopathy nor an underlying neonatal disorder was detected.

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“…The exact mechanism for the development of PABS remains unclear, but one plausible explanation is that PABS is consequence to the inadvertent septostomy during the invasive procedure, creating free-floating amniotic sheets, which entrap the fetal parts and umbilical cord. [1][2][3][4][5][6] In one series, septostomy was reported to occur in 7% of cases after SLPC and accounted for 50% of PABS cases. 4 Another plausible mechanism for the development of PABS is postoperative chorioamniotic membrane separation (CMS), which is common after fetoscopic surgery, occurring in 47% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication of invasive antenatal procedures, such as amniorreduction, septostomy, fetoscopic laser photocoagulation and bipolar cord coagulation in monochorionic twin-twin transfusion syndrome (TTTS). [1][2][3][4][5] The reported incidence is 1.8-3.3% after invasive procedures. [1][2][3] Selective fetoscopic laser photocoagulation (SFLP) of twin anastomoses on the chorionic plate has proved to improve survival in severe TTTS and is now offered widely as the first line treatment for severe TTTS presenting before 26 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

Cunha¹,

Coutada²,

Neiva³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication that occurs after invasive procedures in monochorionic twins for treatment of twin-twin transfusion syndrome (TTTS). Selective fetoscopic laser photocoagulation (SFLP) is a commonly performed procedure for the treatment of severe TTTS that may lead to complications such as preterm labor, preterm rupture of membranes, cerebral lesions and fetal death. PABS has been reported to occur in up to 3% of cases of TTTS treated with laser, leading to limb abnormalities. There are no identifiable risk factors and antenatal detection of PABS is rare, but possible. Thus, obstetricians should be aware of this possibility in pregnancies treated by laser therapy for TTTS. The authors report a case of a monochorionic biamniotic twin pregnancy submitted to SFLP for TTTS at 19 weeks of gestation with postnatal diagnosis of PABS, presenting with amputation of a fetal limb.

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Laser therapy for twin-to-twin transfusion syndrome causing amniotic band syndrome

Cited by 7 publications

References 2 publications

Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review

Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review

Disseminated intravascular coagulation complicated by amniotic band syndrome associated with deceased fetal umbilical cord following fetoscopic laser surgery

Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

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