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Twisting of the umbilical cord around the left upper extremity, causing a strangulation of the umbilical cord
Source publication
The amniotic band syndrome has a scarce prevalence and intrauterine death as a result of amniotic bands formation is extremely rare.
We present an illustrative case of intrauterine death of an embryo in the 24th gestational week in an 30-year old primigravida. The death was ascribed to the twisting of the umbilical cord around the left upper extrem...
Citations
... We reviewed the Pubmed literature from 1992 to 2018, and totally 11 fetuses whose found umbilical cord entangled by amniotic bands, 8 died in utero and 3 survived. [2,[5][6][7][8][9][10] The poor prognosis of the fetus may be due to compression or constriction of the umbilical cord, which is also the reason of fetal intrauterine death in this group. The fetal hand and umbilical cord were simultaneously adhered by the amniotic bands, which caused the compression of umbilical cord. ...
Rationale:
The significant ultrasonic characteristics of amniotic band syndrome (ABS) are the malformations of fetal affected parts and the band-like echoes in amniotic cavity. This article first suggests that the fetal hand adhered to umbilical cord with restricted movement provides some values in the diagnosis of ABS in early gestational weeks especially when the fetal malformation is not obvious and amniotic band is thin and fine.
Patient concerns:
Two pregnant women had no discomfort and underwent routine ultrasound examination at 11 to 14 gestational weeks.
Diagnosis:
Only the fetal hand adhered to umbilical cord with restricted movement was detected during the first ultrasound examination at 11∼14 gestational weeks, and the floating band-like echos were detected in the amniotic cavity with follow-up examinations 2 to 3 weeks later. Both of the 2 fetus were diagnosed as ABS by ultrasound INTERVENTIONS:: The two pregnant women underwent the prenatal counseling and were recommended closely follow-up and further examination.
Outcomes:
Two fetuses died in utero between 17 and 19 weeks. After induction of labor, it was found that the hands and umbilical cord of the fetuses were wrapped by amniotic bands, which was proved pathologically as ABS.
Lessons:
The adhesion of the fetal hand and umbilical cord is an important ultrasonic sign suggesting ABS with poor prognosis in early pregnancy. We hope that this study can provide some guidance for the early diagnosis of ABS during 11 to 14 week's ultrasound examination.
... Umbilical cord constriction by an amniotic band has been described many times in singletons with amniotic band syndrome [15][16][17][18][19] and PABS after amniocenteses, 3,20 amnioreduction, or even spontaneous septostomy. 21 It must be considered when reduced fetal movement or growth restriction is observed in pregnancies that have had invasive procedures. ...
Pseudoamniotic band syndrome is a rare complication that occurs after invasive procedures for complicated monochorionic twins. We report 2 cases of intrauterine recipient fetal death after laser therapy for twin-twin transfusion syndrome due to umbilical cord constriction by the amniotic band.
... In one case, strangulation of umbilical chord by amniotic band had occurred which caused death of the fetus in the third trimester. This indicated the unpredictability of the manifestations of this syndrome [12]. ...
... Existen dos teorías, la endógena propuesta por Streeter en 1930, que supone que ciertos errores del desarrollo en la formación del tejido conectivo de las extremidades causan anomalías 8 y la fuerza mecánica de las bandas amnióticas compromete la vascularización fetal, alterando la programación y organización básica del feto durante la embriogénesis; 1,9 por otro lado, la teoría exógena, la más aceptada 10 y propuesta por Torpin en 1965, describe la ruptura temprana del amnios 1,11 y existencia de oligohidramnios, con daño de las partes fetales por el contacto del feto con el mesodermo de la cavidad coriónica y desarrollo de bandas fibrosas desde la superficie del amnios fragmentado que atrapan estructuras y causan anillos de constricción en dedos, amputaciones y abrasiones de la piel que producen los defectos de disrupción. 1,8,10,11 Otras anomalías existentes (como las de órganos internos) no pueden ser explicadas por las teorías anteriores, por lo cual Lockwood 12 propuso una tercera teoría, llamada vascular, donde los daños vasculares fetales superficiales producen sangrado, ulceraciones y lesiones ectodérmicas con amputaciones posteriores 1,10 Van Allen y cols. (1992) presentan evidencia de infartos uterinos por émbolos que pueden causar defectos terminales de reducción de extremidades y anillos de constricción similares a los de la SBA en ausencia de anomalías del amnios. ...
... Unfortunately, in our case, the diagnosis of amniotic band was not determined during pregnancy. Only rare cases of strangulation of umbilical cord by amniotic band have been described in the literature, most of whom were stillborn [4,7]. The cause of fetal death during labor is that the contraction intense enough to stop the blood flow through the umbilical cord constriction by amniotic band, determining severe fetal hypoxia [8]. ...
We describe an extreme case of amniotic band syndrome, presented with fetal stress during labor and associated with strangulation of umbilical cord.
Truncus arteriosus, interrupted aortic arch and amniotic band syndrome are rare conditions. We report a case of a 38-year-old pregnant woman who was diagnosed on a routine morphological ultrasound scan with a Van Praagh type A4 persistent truncus arteriosus with an aortic arch interruption type B and abnormal limbs (oedematous left hand, hypoplastic fingers on the right hand and right big toe amputation). Elective termination of the pregnancy was carried out and the pathological examination confirmed all the sonographic findings. Furthermore, an amniotic band parallel to the umbilical cord undetected during the ultrasound scans was revealed, and was entangled around the right hand, left wrist and the umbilical cord, causing strangulation. We present the unusual association of these independent pathologies and emphasise the usefulness of fetal autopsy in all cases of pregnancy termination and abnormal ultrasound findings to make the complete diagnosis.
Objective:
To describe the spectrum of clinical deformities related to amniotic band sequence (ABS), ranging from mild to severe.
Methods:
Retrospective evaluation of 9 cases of ABS managed during a 4-year period (February 2006 to April 2010) in a tertiary hospital.
Results:
The median gestational age at prenatal diagnosis was 15 weeks (range 11-26). Only 2 patients had clinical prenatal evidence of amnion rupture. In the other 5 cases the diagnosis of ABS was established prenatally based on fetal structural abnormalities. These abnormalities included: (1) upper limb defects: syndactyly, amputation at the level of phalanges or first metacarpal or forearm; (2) inferior extremities defects: tallus equinovarus and flexed knee, and constriction ring; (3) umbilical cord strangulation, and (4) acrania.
Conclusion:
ABS is a polymorphous syndrome and recognizing its various manifestations can be of help in prenatal identification.
Amniotic band syndrome is an uncommon congenital pathological condition that may lead to malformations and foetal-infant death. We report an autoptic case. The patient was a male preterm infant. At 14 weeks of gestation, a routine ultrasonography showed severe craniofacial anomalies and a close contiguity of the foetal head with the amnios. The neonate survived three days, after which an autopsy was carried out. The infant had a frontoparietal meningoencephalocele; a fibrous band was attached to the skin, close to the meningoencephalocele base. Cleft lip and palate, nose deformation and agenesis of the right eye were also present. At the opening of the cranial cavity, occipital hyperostosis was observed. The herniated brain showed anatomical abnormalities that made identification of normal structures difficult. Microscopically, the nervous parenchyma had architectural disorganization and immaturity, and the fibrous band consisted of amniotic membranes. As evident from this case report, amniotic band syndrome may cause severe malformations and foetal-infant death.
