In utero lysis of amniotic bands

Abstract

Amniotic band syndrome is a sporadic condition that occurs in approximately 1:1200 to 1:15,000 live births and that may result in amputations, constrictions and other deformities of the fetus. Although some cases present with congenital anomalies that are beyond surgical repair, a selected group of fetuses may show isolated limb constriction. It has been speculated that, without treatment, amputation or severe dysfunction of the limb may occur. Despite these potential complications, surgical treatment for this selected group of fetuses has not been previously performed. We report two cases that were successfully treated using novel minimally invasive surgical techniques. The cases involved fetuses with amniotic band syndrome with associated limb constriction in which the amniotic band was surgically interrupted to avoid spontaneous amputation of the extremity. Adequate blood flow distal to the obstruction was preserved and significant functional improvement of the extremity occurred in both cases, preserving the limbs. These cases represent the first prenatal surgical intervention successfully used to treat constricting amniotic bands in humans. In addition, these cases represent the first time that a non-lethal fetal entity has been surgically treated in utero. The results of this innovative therapy will encourage the efforts to continue developing minimally invasive techniques for the correction of birth defects.

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

“…In two other cases uterine wall and intra-amniotic bleeding led to removal of the second port (which was being used for the fetoscope). In these two cases the amniotic bands were released successfully under ultrasound guidance 6 . Postoperative subchorionic bleeding and membrane separation, with amniotic fluid loss within the first 24 hours after surgery, seem to be directly related to this procedure 5,18 .…”

“…These findings have been confirmed in both animal and human studies 3−9 . The first two cases of antenatal release of amniotic bands that were causing ischemia of the extremities were reported in 1997, and the outcomes suggested that the operation could result in significant functional improvement 6 . Since then, nine studies on in-utero treatment of ABS have been reported in the literature, with further support for the view that release of the bands may prevent intrauterine fetal death.…”

Amniotic Constriction Band: A Multidisciplinary Assessment of Etiology and Clinical Presentation

“…Much milder findings with a near normal limb appearance were noted when the band was released fetoscopically twenty-five days later. Others [47][48][49] reported fetoscopic release at approximately twenty weeks gestation in humans, with improvement in the appearance of the extremities. These reports do not advocate isolated fetoscopic release, as the risks of such intervention are high.…”

Amniotic band syndrome: a report of two cases and review of the literature

“…30 In utero, with the use of obstetric ultra sound scan, amniotic bands can be seen as linear echoes floating in the amniotic fluid and connected to the foetal body. 31 In the index cases however, the diagnosis of ABS was missed by obstetric ultra sound scan done at 15 weeks and 26 weeks respectively.…”