Fetoscopic Release of an Amniotic Band with Risk of Amputation: Case Report and Review of the Literature

Richter, Jute; Wergeland, Håkon; DeKoninck, Philip; Catte, Luc De; Deprest, Jan

doi:10.1159/000335026

Cited by 32 publications

(38 citation statements)

References 27 publications

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“…The presentation for extremity involvement can be late, after amputation has already occurred, or early when there is still an opportunity for fetoscopic band release for limb salvage. Extremity involvement is a widely accepted indication for a fetal intervention [5,16,17]. Of the 20 patients with limb involvement in our series, 9 presented early enough that fetoscopic band release was considered.…”

Section: Discussionmentioning

confidence: 99%

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Amniotic Band Syndrome: A Single-Institutional Experience

Iqbal¹,

Derderian²,

Cheng³

et al. 2014

Fetal Diagn Ther

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Introduction: Amniotic band syndrome (ABS) is uncommon. We review our single-institutional experience to define its natural history and outcomes. Materials andMethods: We conducted a retrospective analysis from a single, tertiary referral center of patients evaluated for and confirmed to have ABS from 1997 to 2012. Results: Twenty-eight patients had confirmed ABS. The mean ± SD maternal age was 27.9 ± 5.9 years, and the mean gestational age at diagnosis was 20.7 ± 3.8 months. Oligohydramnios was reported in 4 patients. Eleven patients had membrane disruption, of whom 4 had undergone a prior percutaneous intervention. Extremities were the most common site affected (n = 20), followed by the umbilical cord (n = 7), abdomen (n = 5), limb-body wall complex (n = 5), head (n = 1), and chest (n = 1). Nine patients were felt to be candidates for fetal intervention; 5 underwent fetoscopic amniotic band lysis with 4 survivors. Overall survival, excluding 3 terminations, was 74%. There were 5 fetal demises and one neonatal death. Cord involvement was higher in nonsurvivors (67%) compared to survivors (19%, p = 0.05). Discussion: ABS most commonly involves the extremities. Membrane disruption is not always present. Fetoscopic lysis is appropriate for select patients, and special consideration should be given for cord involvement, which is associated with a worse outcome.

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Section: Discussionmentioning

confidence: 99%

“…Given the wide spectrum of disease, the true incidence of ABS is difficult to ascertain and has been estimated to be 1:1,200 to 1:15,000 live births [5,6]. The etiology is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Amniotic Band Syndrome: A Single-Institutional Experience

Iqbal¹,

Derderian²,

Cheng³

et al. 2014

Fetal Diagn Ther

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“…Once impaired blood flow as compared with the contralateral limb is detected, fetoscopic release of the amniotic bands could salvage the limb from amputation. Ten cases of successful intrauterine release of amniotic bands involving the fetal limbs in singleton pregnancy have been reported [13,14,15,16,17,18,19]. Seven (70%) had full functional recovery after delivery.…”

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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“…Indeed, recent reports have demonstrated the success of fetal intervention in non-lethal conditions (meningomyelocele, congenital diaphragmatic hernia) although postintervention complications, particularly preterm premature rupture of membranes (PPROM), remain a concern 8,9 . Keeping in mind that there are probably several unpublished cases of treatment with unsuccessful procedures, knowledge of which might be beneficial for understanding the outcome, we present our initial experience at a single center and a review of the literature on fetoscopic release of amniotic bands.…”

Section: Introductionmentioning

confidence: 99%