Salvage Surgery of the Limb with Severe Pseudoamniotic Band Syndrome: Case Report and Literature Review

Çöloğlu, Harun; Özkan, Burak; Çöloğlu, Özlem; Yalçınkaya, Cem; Uysal, Ahmet Çağrı; Borman, Hüseyin

doi:10.1055/s-0033-1358452

Cited by 4 publications

(2 citation statements)

References 6 publications

(7 reference statements)

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“…Nonetheless, diagnosing amniotic band syndrome (ABS) in utero presents considerable challenges. Fetal CT is employed as a secondary diagnostic tool to enhance prenatal assessment, enabling a detailed evaluation of the fetal skeletal structure (Haase & Merkel, 2008;Çöloğlu et al, 2014;Arshad & McCarthy, 2009).…”

Section: Resultsmentioning

confidence: 99%

Upper limb ischemia at birth

Al-Ahmadi,

Jayar

2024

ijhs

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The aim of this case report: is to present and discuss the clinical features, diagnostic challenges, management strategies, and outcomes of two cases involving upper limb ischemia in neonates. By examining these cases, we aim to contribute to the understanding of the underlying causes, diagnostic pathways, and potential interventions for neonates presenting with upper limb ischemia, emphasizing the importance of early diagnosis and appropriate management to minimize complications and enhance patient outcomes. Discussion Summary: ABS presents a range of fetal abnormalities caused by fibrous bands in the womb, leading to deformities and developmental interruptions. Limb constriction rings are common, potentially resulting in limb loss or digit deformities. Neonatal limb ischemia, particularly acute limb ischemia, is rare but associated with catheterization. In utero compression ischemia, often affecting the brachial artery, can lead to limb ischemia. Risk factors include maternal conditions like diabetes, dehydration, and more. Proper delivery planning is crucial for macrosomic infants. Diagnosis and management of neonatal limb ischemia are challenging. Doppler ultrasound is the primary diagnostic tool, with fetal CT enhancing prenatal assessment. Thrombolytic therapy, including alteplase and heparin, is a common treatment.

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Section: Resultsmentioning

confidence: 99%

Upper limb ischemia at birth

Al-Ahmadi,

Jayar

2024

ijhs

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“…PABS is most commonly reported as a consequence of fetoscopic laser surgery (FLS) in monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) [5][6][7][8][9][10][11][12]. Less commonly, PABS cases were reported secondary to amnioreduction [13], amniocentesis [14][15][16], and fetal cord coagulation procedures [17]. The pathophysiology of PABS following fetal intervention procedures could be explained either by an iatrogenic septostomy during the procedure or by postoperative chorioamniotic membrane separation [5].…”

Section: Introductionmentioning

confidence: 99%

Prenatal Risk Factors and Outcomes of Pseudoamniotic Band Sequence following Fetoscopic Laser Surgery: Systematic Review, and Meta-Analysis

Mustafa,

Aghajani,

Verma

et al. 2023

Fetal Diagn Ther

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Introduction: To investigate prenatal risk factors and perinatal outcomes for pregnancies involving pseudoamniotic band sequence (PABS) after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndromes (TTTS) and compare outcomes between those undergoing fetoscopic band release vs. not. Methods: We conducted a systematic search of PubMed, Scopus, and Web of Science on studies reporting PABS following FLS for TTTS. A meta-analysis of pooled proportions was conducted. Results: There were 16 studies covering 47 pregnancies complicated by PABS following FLS, mostly case series and case reports. The incidence of PABS was 2%, with the recipient twin affected in 94% of the cases. Pregnancies complicated by PABS were associated with inter-twin septostomy in 32% and chorioamniotic separation (CAS) in 90%. The mean gestational age (GA) at FLS and delivery were 17.7 and 30.9 weeks respectively. Preterm premature rupture of membranes (PPROM) happened in 62% of pregnancies. The risk of preterm birth (PTB) <34 weeks, <32 weeks, and <28 weeks were 94%, 67%, and 31%, respectively. There were 41% fetal demises and 64% live births among the affected fetuses. Results of fetoscopic band release versus not were comparable, including GA at delivery, PPROM, and PTB at 32 weeks. It was noted that the likelihood of PTB by 28 weeks (67% vs 23%) and fetal death (50% vs 39%) were higher in the band release group. It was similar between groups in terms of postnatal amputation. Conclusion: PABS causes amputations or fetal death in more than one-third of cases. Pregnancies with an inter-twin septostomy, CAS, advanced TTTS staging, and early GA are more likely to experience PABS. In addition, more than a third of FLS-treated TTTS resulted in PTB and PPROM. PABS cases with prenatal band release showed higher rates of PTB and fetal death, but the data were from small, heterogeneous studies.

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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

Knijnenburg

Slaghekke

Tollenaar

et al. 2020

American Journal of Obstetrics and Gynecology

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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, 1.12e1.79; P¼.003) and the presence of postprocedural chorioamniotic membrane separation on antenatal ultrasound examination (odds ratio, 41.66; 95% confidence interval, 5.44e319.25; 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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Salvage Surgery of the Limb with Severe Pseudoamniotic Band Syndrome: Case Report and Literature Review

Cited by 4 publications

References 6 publications

Upper limb ischemia at birth

Upper limb ischemia at birth

Prenatal Risk Factors and Outcomes of Pseudoamniotic Band Sequence following Fetoscopic Laser Surgery: Systematic Review, and Meta-Analysis

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

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