Ghent University (UGent), Ghent University Hospital (UZ Gent), Belgium.
Ghent University (UGent), Ghent University Hospital (UZ Gent), Belgium.
Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:264-266. doi: 10.1016/j.ejogrb.2024.04.010. Epub 2024 Apr 14.
Amniotic banding is a rare condition that can lead to structural limb anomalies, fetal distress and adverse obstetric outcomes. The main hypothesis for its etiology is a rupture of the amniotic membrane in early pregnancy, with the formation of tightly entangling strands around the fetus. These strands can constrict, incise, and subsequently amputate limb parts, the neck or head. More rarely, the amniotic banding can affect the umbilical cord, leading to fetal distress or potential intra-uterine fetal demise.
We present a unique case of a 26-week pregnant woman who attended a polyclinical consultation due to reduced fetal movements with concerning cardiotocography (CTG) findings. A review of the literature about amniotic banding of the umbilical cord was conducted as well, identifying diagnostic and interventional options for the obstetrician's practice.
This is a case report, alongside a review of the literature.
The CTG indicated fetal distress, prompting an emergency caesarean section (C-section). Upon delivery, the neonate exhibited signs of amniotic band sequence, with distal phalangeal defects on the right hand and severe constriction of the umbilical cord caused by amniotic strands, the latter precipitating fetal hypoxia. Direct ultrasound diagnosis remains a challenge in the absence of limb amputation, yet indirect signs such as distal limb or umbilical doppler flow abnormalities and distal limb edema may be suggestive of amniotic banding. MRI is proposed as an adjuvant diagnostic tool yet does not present a higher detection rate compared to ultrasound. Fetoscopic surgery to perform lysis of the amniotic strands with favorable outcome has been described in literature.
This case presents the first reported survival of an extremely preterm fetus in hypoxic distress as a cause of amniotic banding of the umbilical cord, with a rare degree of incidental timing. Ultrasound diagnosis remains the gold standard. Obstetrical vigilance is warranted, with fetal rescue proven to be feasible.
羊膜带综合征是一种罕见的疾病，可导致结构肢体异常、胎儿窘迫和不良产科结局。其病因的主要假说是妊娠早期羊膜破裂，在胎儿周围形成紧密缠绕的束带。这些束带可收缩、切割，并随后切断肢体部分、颈部或头部。更罕见的是，羊膜带综合征可影响脐带，导致胎儿窘迫或潜在的宫内胎儿死亡。
我们报告了一例独特的 26 周孕妇病例，她因胎儿运动减少并伴有令人担忧的胎心监护（CTG）结果而就诊于多科会诊。我们还对脐带羊膜带的文献进行了回顾，确定了产科医生实践中的诊断和干预选择。
这是一个病例报告，以及对文献的回顾。
CTG 提示胎儿窘迫，促使紧急剖宫产（C -section）。分娩时，新生儿出现羊膜带序列的迹象，右手远端指骨缺陷，脐带严重受压，由羊膜带引起，后者导致胎儿缺氧。在没有肢体截肢的情况下，直接超声诊断仍然具有挑战性，但间接征象如远端肢体或脐带多普勒血流异常和远端肢体水肿可能提示羊膜带。MRI 被提议作为一种辅助诊断工具，但与超声相比，并未提高检测率。文献中描述了羊膜带松解的胎儿镜手术以获得良好的结果。
本病例首次报道了因脐带羊膜带导致极度早产儿在缺氧窘迫中的存活，且时机罕见。超声诊断仍然是金标准。需要产科警惕，胎儿抢救已被证明是可行的。
