Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin‐Twin Transfusion Syndrome: Two Case Reports and Systematic Review

Lafitte, Anne Sophie; Verspyck, É.; Pasquier, Corinne; Dolley, P.; Dreyfus, Michel; Benoist, G.

doi:10.1002/jum.14295

Cited by 8 publications

(21 citation statements)

References 31 publications

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“…In the largest series, the recipient is more frequently affected by PABS. [1][2][3][4] This could be explained by an amniotic fluid excess allowing more fetal movements in the recipient than the donor. In our case, the affected fetus was the donor, perhaps because amniotic fluid was normalized after SLPC.…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication of invasive antenatal procedures, such as amniorreduction, septostomy, fetoscopic laser photocoagulation and bipolar cord coagulation in monochorionic twin-twin transfusion syndrome (TTTS). [1][2][3][4][5] The reported incidence is 1.8-3.3% after invasive procedures. [1][2][3] Selective fetoscopic laser photocoagulation (SFLP) of twin anastomoses on the chorionic plate has proved to improve survival in severe TTTS and is now offered widely as the first line treatment for severe TTTS presenting before 26 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiologic mechanism of PABS is based on two hypotheses: inadvertent septostomy during invasive procedure and postoperative chorioamniotic membrane separation. [1][2][3] Regardless of the mechanism, it can cause umbilical cord compression in a constrictive sheet or detachment of the ruptured amniotic membrane, with a risk of fetal limb constriction or amputation, facial cleft and even intrauterine death when the umbilical cord is involved. [1][2][3][4] Few data are available concerning PABS.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only 27 cases had been reported and fetal limbs were involved in 15 cases, leading to constriction or amputation. 3…”

Section: Introductionmentioning

confidence: 99%

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Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

Cunha¹,

Coutada²,

Neiva³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication that occurs after invasive procedures in monochorionic twins for treatment of twin-twin transfusion syndrome (TTTS). Selective fetoscopic laser photocoagulation (SFLP) is a commonly performed procedure for the treatment of severe TTTS that may lead to complications such as preterm labor, preterm rupture of membranes, cerebral lesions and fetal death. PABS has been reported to occur in up to 3% of cases of TTTS treated with laser, leading to limb abnormalities. There are no identifiable risk factors and antenatal detection of PABS is rare, but possible. Thus, obstetricians should be aware of this possibility in pregnancies treated by laser therapy for TTTS. The authors report a case of a monochorionic biamniotic twin pregnancy submitted to SFLP for TTTS at 19 weeks of gestation with postnatal diagnosis of PABS, presenting with amputation of a fetal limb.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only 27 cases had been reported and fetal limbs were involved in 15 cases, leading to constriction or amputation. 3…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

Cunha¹,

Coutada²,

Neiva³

et al. 2018

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…Pseudoamniotic band formation is a rare complication of invasive in-utero interventions and occurs in 1.8-3.3% of cases following fetoscopic laser photocoagulation for twin-twin transfusion syndrome (TTTS) 1,2 . Constricting bands can have serious consequences including limb amputation and umbilical cord accidents 3 .…”

Section: Successful Release Of Pseudoamniotic Bands After Laser Photomentioning

confidence: 99%

Successful release of pseudoamniotic bands after laser photocoagulation for twin–twin transfusion syndrome: utility of partial carbon dioxide insufflation of uterus

Nassr

King

Espinoza

et al. 2020

Ultrasound in Obstet & Gyne

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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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Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin‐Twin Transfusion Syndrome: Two Case Reports and Systematic Review

Cited by 8 publications

References 31 publications

Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report

Successful release of pseudoamniotic bands after laser photocoagulation for twin–twin transfusion syndrome: utility of partial carbon dioxide insufflation of uterus

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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