Paper
P10.04: Amniotic band syndrome first trimester diagnosis and classification
Published Sep 1, 2017 · DOI · F. Ushakov, C. Lia
Ultrasound in Obstetrics & Gynecology
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Abstract
Amniotic band syndrome (ABS) is a cryptic condition associated with variable but mostly adverse outcomes. In the majority of cases ABS develops early in embryological development, however there are no systematic studies describing its diagnosis in first trimester. Our aim is to describe the ultrasound features of ABS in the first trimester, provide clinicians with diagnostic hints and identify the different types of ABS and their outcome. In our tertiary unit we performed about 2800 early pregnancy anomaly scans for high-risk patients between 2009 and 2017. All the cases with diagnosis of ABS were included in this study. 28 cases of ABS were identified. It was possible to classify all cases seen into 4 main groups: Amniotic Net: Characterised by multiple amniotic bands attached to the fetus or free-floating. These fetuses have multiple severe asymmetric anomalies: atypical facial clefts, brain anomalies, thoraco-abdominal wall defects and limb anomalies. Dividing Amnion: An obviously intact amniotic membrane divides the fetus into intra-amniotic and extra-amniotic parts. Amniotic Connection: An isolated single amniotic band connects the fetus to the chorion. This was present in 2 cases of ectopia cordis, 1 exencephaly and 1 case of sacral attachment. With progression of the pregnancy the amniotic band appeared to rupture and disappear. Baby in an Envelope: An unusual anomaly presenting with reduced volume of amniotic sac in first trimester resulting in fetal entrapment and secondary rupture of the sac in early second trimester. This type of ABS was associated with talipes and limb reductions. In many of the cases reviewed, the amniotic bands were undetectable or poorly visible on transabdominal scan. Transvaginal examination is deemed essential for visualisation of the bands and correct diagnosis. Diagnosis of ABS is feasible in first trimester. The etiology of this spectrum of conditions remains obscure but with further comprehensive study and a standard classification we might be better equipped to further diagnose and understand these conditions.
Amniotic band syndrome (ABS) diagnosis is feasible in the first trimester, with four main groups and a need for transvaginal examination for accurate diagnosis.
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