Pseudoamniotic Band Syndrome after In Utero Intervention for Twin-to-Twin Transfusion Syndrome: Case Reports and Literature Review

Abstract

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.

Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant Oligohydramnios

“…The survival rate without BA for at least one neonate in 52 cases was 94%. The incidence of complications related to FLP in women carrying sIUGR twins was lower than the incidence in those with TTTS [17-20]. Considering the extremely poor perinatal outcomes of those with abnormal UA Doppler waveforms and oligohydramnios undergoing conservative management [4, 5], FLP for these patients might possibly have a certain degree of effect.…”

Incidental Septostomy after Laser Surgery for Twin-Twin Transfusion Syndrome: Perinatal Outcomes and Antenatal Management

“…These findings are consistent with a large retrospective analysis by Peeters et al [6] which found that patients with iatrogenic rupture of the intertwin membrane who were being treated for TTTS with laser surgery had a lower GA at birth and increased neonatal morbidity. Amniotic band formation is an additional complication seen in patients with disruption of the intertwin-dividing membrane in monochorionic multiple gestations [3, 8, 11, 14, 15]. …”

“…Pseudoamniotic band syndrome was diagnosed if there was evidence of amniotic bands on postoperative ultrasound or at delivery. Pseudoamniotic band syndrome is an iatrogenic complication after invasive in utero procedures where free-floating amniotic bands may be subsequently formed [11]. …”

Anomalies of the placenta and umbilical cord in twin gestations

“…56,66-69 Septostomy can be associated with amniotic membrane flaps and induce a pseudoamniotic band syndrome in 2-3% of the cases involving the limbs or the umbilical cord and leading to amputation and intrauterine death. 70 Therapeutic septostomy is controversial in TTTS but has been associated with an improvement of fetal and neonatal morbidity, also due to concomitant amniodrainage. 57,71 An intertwin membrane hematoma is a rare complication of DCDA twins generally associated with the development of a subchorionic hematoma under the insertion of the membrane.…”