Outcomes of prenatally diagnosed spontaneous chorioamniotic membrane separation in singleton pregnancies: A systematic review of case series and case reports

Abstract

Objectives: To provide an overview of perinatal outcomes in prenatally diagnosed spontaneous chorioamniotic separation (sCAS). Methods: A systematic search of the literature was performed from inception to July 2019, including PubMed, Ovid MEDLINE, and Ovid EMBASE. All studies reporting prenatally diagnosed sCAS after 16 weeks' gestation in singleton pregnancies were eligible. Two independent reviewers used standardized forms for data abstraction. Results: Of 408 screened abstracts, 17 studies reporting 118 cases of sCAS were included. Among 113 cases with delivery outcomes, preterm birth (PTB) occurred in 60 (53.1%, 95% confidence interval [CI] 43.9-62.3%). Intrauterine fetal demise (IUFD) occurred in seven (6.2%, 95% CI 1.8-10.6%) cases, with four due to cord strangulation. Spontaneous abortion occurred in one (0.88%, 95% CI-0.84-2.6%) case. Among 104 cases with postnatal follow-up, there were six (5.8%, 95% CI 1.3-10.3%) neonatal deaths and one (0.96%, 95% CI-0.91-2.8%) infant death. Perinatal mortality (IUFD and neonatal deaths) was 11.0% (95% CI 5.4-16.7%). Conclusions: sCAS may be associated with increased risk of PTB, however, the available data are largely case reports and series. Antepartum surveillance after viability can be considered due to risk of cord accidents. Prospective study is necessary to understand the clinical implications of sCAS.

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience

“…Although the incidence and the etiology of fetal death after FETO remain unclear, unexpected fetal death after FETO might occur and some cases associated with CMS may have resulted in umbilical cord compromise. Even in singleton pregnancies with spontaneous CMS, fetal death occurred in 6% of cases, with more than half of these deaths occurring due to cord strangulation 34 . CMS after FETO should be recognized as a risk factor for not only pPROM but also for an umbilical cord accident leading to fetal death.…”

“…Even in singleton pregnancies with spontaneous CMS, fetal death occurred in 6% of cases, with more than half of these deaths occurring due to cord strangulation. 34 CMS after FETO should be recognized as a risk factor for not only pPROM but also for an umbilical cord accident leading to fetal death.…”

Perinatal outcomes of iatrogenic chorioamniotic separation following fetoscopic surgery: systematic review and meta‐analysis

“…Although in this review we were not able to comment on additional possible complications associated with iCAS, such as the risk of pseudoamniotic band formation and cord accidents, due to lack of reporting in the included studies, these concerns have been described in cases of spontaneous CAS and individual case reports following intervention 5,14,16 .…”

“…The term CAS is used to indicate detachment of the two membranes after documented fusion as evidenced by prenatal ultrasound 3,4 . A recent systematic review evaluating the outcomes of spontaneous CAS in singleton pregnancies demonstrated an increased risk for preterm delivery and a possible increase in the risk for intrauterine fetal demise, mainly due to umbilical cord accidents 5 .…”

Concomitant spontaneous chorioamniotic membrane separation, velamentous cord insertion and vasa previa

“…There have been no previous reported cases of spontaneous chorioamniotic separation with concurrent vasa previa. Chorioamniotic separation increases significantly the risk of preterm prelabor rupture of membranes and preterm delivery [2][3][4] ; the concomitant presence of vasa previa increases the risk of severe and acute bleeding and fetal death. Despite the concern regarding perinatal mortality related to vasa previa, there are insufficient data to suggest that inpatient management reduces significantly the risk of adverse outcome 5 .…”