Constriction of an Extremity after Amnioreduction in a TRAP-Like Sequence

Abstract

We present an unusual case of TRAP sequence (twin reversed arterial perfusion) with persistent polyhydramnios despite spontaneous thrombosis of the vena umbilicalis of the acardius. Serial amnioreduction was performed owing to considerable maternal discomfort and preterm labor. After three procedures, spontaneous abortion occurred. Unexpectedly, the normal twin had an apparently recent constriction of the right forearm. We hypothesize that limb constriction could be a rare but specific complication of aggressive amnioreduction.

Limb Constriction Secondary to Pseudoamniotic Band Syndrome after Selective Fetoscopic Laser Surgery: Report of a Case with a Favorable Outcome

“…Some techniques like amniopatch [10] have been attempted to reduce the rate of complications, with variable results. Little or no data are presented on the incidence of PABS, where there is entanglement of fetal parts in a constrictive sheet of detached or ruptured amniotic membrane after invasive procedures such as amniocentesis [11,12,13], amnioreduction [14], or septostomy in twins [15]. In a smaller retrospective study by Habli et al [16] involving 152 patients with TTTS who were treated with SFLP at 16–26 weeks of gestation, 5 cases (3.3%) had PABS.…”

Complete Chorioamniotic Membrane Separation

“…Of the 47 reported cases, 29 patients (62%) had amniocentesis; 2 patients (4%) underwent amniodrainage for polyhydramnios [12,14]; 5 patients (11%) had in utero fetal surgery by hysterotomy for diaphragmatic hernia [10]; 1 patient (2%) had chorion villus sampling at 9 weeks of gestation [11], and, finally, 10 cases of CMS (21%) occurred spontaneously, of whom 1 had polyhydramnios associated with encephalocele [12].…”

Acardiac Twins: Pathophysiology, Diagnosis, Outcome and Treatment

“…Repeated amniocentesis has been performed to relieve the mother from painful distension of the uterus and abdominal wall [2,3,25,26]. Furthermore amniocentesis may prevent preterm labour initiated by the distended uterus and sometimes be used in a combination with tocolytics.…”

“…Amniocentesis may lead to abruptio placentae and chorioamniotis, and a rare severe complication is prenatal constriction of an extremity due to the formation of an amniotic detachment that can be detected by ultrasound [3]. Use of amniocentesis in polyhydramnios is known to produce large variations in fetal blood flow including cerebral flow.…”

“…The normal twin (donor) circulates the acardiac twin (recipient), which is kept 'alive' through vascular anastomoses. The blood flow in the acardiac twin is characterised by a reversed arterial perfusion leading to the alternative terminology TRAP (twin reversed arterial perfusion) [1][2][3]. In some cases an abnormal heart beating can be seen at ultrasound examination of the acardiac twin.…”