Graf J L, Bealer J F, Gibbs D L, Adzick N S, Harrison M R
Department of Surgery, University of California, San Francisco, USA.
Fetal Diagn Ther. 1997 Mar-Apr;12(2):81-4. doi: 10.1159/000264436.
Sonographic detection of chorioamniotic membrane separation (CMS) has been considered a benign incidental finding. We now report 6 cases of CMS identified by prenatal ultrasound; 1 in an otherwise normal pregnancy and 5 following fetal surgery. Following membrane separation, amniotic bands formed and compromised the umbilical cord in 4 cases leading to 2 fetal deaths. In the first case, CMS was detected by ultrasound at 22 weeks' gestation in an otherwise uncomplicated pregnancy. Because CMS was considered benign and umbilical cord blood flow was ample, the mother was followed by intermittent sonographic examinations. Fetal demise occurred 2 weeks later, clearly due to umbilical cord strangulation by an amniotic band. Surprised by this unexpected outcome, we reviewed our experience with CMS after hysterotomy for fetal surgery. Out of more than 40 fetal surgical cases, we have 5 cases in which CMS was recognized after hysterotomy. Three of these fetuses had umbilical cord compromise by a band of amniotic membrane leading to 1 fetal death. This experience demonstrates that membrane separation may be associated with amniotic band formation which can lead to cord strangulation and fetal compromise. Following fetal surgery, serial ultrasound evaluation and close fetal monitoring are indicated. In otherwise unremarkable pregnancies, clinician awareness of the possibility of amniotic band formation following CMS should be heightened. In either situation, knowledge of this potential life-threatening complication may identify cases in which cord compromise requires emergent delivery or fetoscopic release of the strangulating amniotic band.
超声检测到绒毛膜羊膜分离（CMS）一直被认为是一种良性的偶然发现。我们现在报告6例经产前超声确诊的CMS病例；1例发生在其他方面正常的妊娠中，5例发生在胎儿手术后。膜分离后，4例形成羊膜带并累及脐带，导致2例胎儿死亡。第一例中，在妊娠22周时超声检测到CMS，该妊娠在其他方面无并发症。由于CMS被认为是良性的且脐带血流充足，对母亲进行了间歇性超声检查随访。2周后发生胎儿死亡，显然是由于羊膜带绞窄脐带所致。我们对这一意外结果感到惊讶，于是回顾了我们在胎儿手术后CMS方面的经验。在40多例胎儿手术病例中，有5例在子宫切开术后发现CMS。其中3例胎儿因羊膜带导致脐带受压，导致1例胎儿死亡。这一经验表明，膜分离可能与羊膜带形成有关，羊膜带可导致脐带绞窄和胎儿受损。胎儿手术后，应进行系列超声评估和密切的胎儿监测。在其他方面无异常的妊娠中，临床医生应提高对CMS后羊膜带形成可能性的认识。在任何一种情况下，了解这种潜在的危及生命的并发症可能有助于识别脐带受压需要紧急分娩或通过胎儿镜松解绞窄羊膜带的病例。
