|Year : 2017 | Volume
| Issue : 2 | Page : 121-123
Amniotic band syndrome: A clinical brief
Dasaradha Ramireddy Malireddy, Kamaraju Sailaja, Suresh Thomas, Moulika Mula
Department of Paediatrics, Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
|Date of Web Publication||13-Jun-2017|
Dasaradha Ramireddy Malireddy
Department of Paediatrics, Kamineni Institute of Medical Sciences, Narketpally - 508 254, Nalgonda, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Amniotic band syndrome (ABS) results from bands of amnion entangling fetal parts. They may manifest as constriction rings or complex congenital anomalies resulting in stillbirth. Karyotyping is important for exclusion of inherited disorders and proper counseling. Two case reports one stillbirth and the other with constriction ring of fingers and mild hydronephrosis are presented. The aim of this paper is to make awareness and stress the need for doing thorough work-up in all cases of constriction bands.
Keywords: Amniotic bands, amniotic band syndrome (ABS), amputation of fingers, constriction rings
|How to cite this article:|
Malireddy DR, Sailaja K, Thomas S, Mula M. Amniotic band syndrome: A clinical brief. J NTR Univ Health Sci 2017;6:121-3
| Introduction|| |
Amniotic band syndrome (ABS) is a set of congenital malformations. Pseudo-ainhum, Streeter's dysplasia, amniotic band sequence, and ABS are the other names used for this condition These congenital malformations occur due to fibrous amniotic bands. Floating amniotic strands entangle fully developed parts such as digits and amputate or involve interruption of blood supply to developing parts causing infarction [Figure 1] and [Figure 2]. They prevent the normal development of fetal parts. These anomalies may be minor involving the fingers leading to shortening or amputation or complex involving the organs and fatal. In the antenatal period, these can be diagnosed by ultrasonography. Karyotyping of the child plays a crucial role in counseling the parents in recurrence risk. These children need individualized multidisciplinary approach.
| Case Report-1|| |
A stillborn baby delivered by caesarian section on 16 October 2012 at 6.45 PM in KIMS hospital at Narketpally. Indication for caesarian was fetal distress with oligohydramnios. It was the first issue for the mother. The mother's age was 18 years. There was history of (H/O) consanguinity, and the antenatal period uneventful. No H/O taking any drugs other than iron and folic acid tablets during pregnancy. There is no history of trauma and quickening was felt at 18wks. Ultrasound done at second and third trimester was normal. Body weight was 1.9 kg. The fetus as seen in the photo showed abnormal face, short neck, and deformities of all limbs [Figure 1]. Low-set ears and micrognathia were prominent. Right forearm that is partly developed had a constricting band. Both the lower limbs are deformed. Constricting bands are seen in both the feet that are malformed.
| Case Report-2|| |
Baby xx was born on 22 March 2013 to a 22-year-old primi by elective caesarian, at KIMS Hospital, Narketpally. It is a booked case, indication for caesarian being Cephalo pelvic disproportion (CPD). The mother had regular antenatal checkups. Antenatal period was uneventful. No maternal H/O trauma, no H/O drug intake except for iron and folic acid tablets in the antenatal period. Ultrasonography of the fetus done at second and third trimester was normal. Apgar score was 8 and 10 at 1 min and 5 min. Birth weight was 2.7 kg. Length was 49 cm. Head circumference was 34.5cm. The baby was found to be active and alert in the second postnatal examination and showed external congenital anomalies, such as oligodactyly and syndactyly with constricting bands, occurring over middle and ring fingers of left upper limb. A fibrous band was noted over the right index finger. Ultrasound of the abdomen showed mild hydronephrosis of left kidney with normal echotexture. The baby's serum creatinine and blood urea were within normal limits. Neurosonogram was within normal limits. Referred to urologist and pediatric surgeon who suggested follow-up. Baby did not develop any other problem and was discharged on third day of life. In both the cases, karyotyping is normal.
| Discussion|| |
Etiology of ABS is unknown. Risk factors are poorly known. However, two theories regarding etiology are popular. One is intrinsic and the other is extrinsic. The extrinsic model explains the rupture of amnion, and subsequent formation of amniotic bands entrapping fetal parts leading to malformations. The intrinsic model proposes that bands and anomalies have a common cause. Most common are limb deformities. They may be constriction rings of fingers or digit or limb amputations and in our second case digit amputations are seen.
Evidence of genetic origin is lacking. Risk factors, such as maternal age, trauma, prematurity, amniocentesis, chorionic villous sampling, and drugs, have been implicated.
Amnion rupture mostly occurs before 12th weeks of gestation. Fetal ultrasonography can detect amniotic bands, constriction rings and amputations as early as 12 weeks of gestational age. ABS defects could be detected mostly during routine ultrasound examinations in the second trimester of pregnancy. Three-dimensional ultrasonography or fetal magnetic resonance may aid in prenatal diagnosis of ABS. Occasionally amputated part may be found in the uterus.
In all cases of constriction rings involving limbs or part of limbs, ABS must be considered as one of the possibilities.
The importance of prenatal diagnosis of ABS lies in the fact that the latest development of fetoscopic techniques in laser cutting of amniotic bands will help in preventing further anomalies. Doppler studies of the constricted limb could be useful and helpful prenatally in determining, when to consider in utero treatment.
It is also useful in properly advising pregnancy termination in fetal anomalies incompatible with life. The treatment involves multidisciplinary approach.
These two cases represent extreme forms of ABS. The one with stillbirth and the second with finger deformities.
| Conclusion|| |
ABS should be considered in all the cases of deformities with constriction rings. When a constriction ring is seen, internal organs should be screened. Karyotyping is essential to give correct information regarding recurrent risk to the parents. It requires a multispeciality team approach in treating these children.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wynshaw-Boris A, Biesecker LG. Dysmorphology. In: Kleigman RM, Stanton BM, St. Geme J, Schor N, Behrman RE, editors. Nelson Text Book of Paediatrics. 19th
ed. New Delhi: Saunders; 2011. p. 788.
Jones KL. Amnion rupture sequence. In: Jones KL, editor. Smith's Recognizable Pattern of Human Malformations. 6th
ed. Philadelphia: Saunders; 2005. p. 732.
Allen LM, Silverman RK, Nosovitch JT, Lohnes TM, Williams KD. Constriction rings and congenital amputations of the fingers and toes in a mild case of amniotic band syndrome. J Diagn Med Sonogr 2007;23:280-5.
Inubashiri E, Hanaoka U, Kanenishi K, Yamashiro C, Tanaka H, Yanagihara T, et al
. 3D and 4D sonographic imaging of amniotic band syndrome in early pregnancy. J Clin Ultrasound 2008;36:573-5.
Diseases and injuries of the foetus and newborn. In: Cunningham FG, Leveno KG, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams Obstetrics. 23rd
ed. USA: McGraw-Hill Companies; 2010. p. 637.
Quintero RA, Morales WJ, Philips J, Kalter CS, Angel JL. In utero
lysis of amniotic bands. Ultrasound Obstet Gynecol 1997;10: 316-20.
Sentilhes L, Verspyck E, Patrier S, Eurin D, Lechevallier J, Marpeau L. Amniotic band syndrome: Pathogenesis, prenatal diagnosis and neonatal management. J Gynecol Obstet Biol Reprod (Paris) 2003;32:693-704.
[Figure 1], [Figure 2]