Amniotic band syndrome
Diagnosis almost certain
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Follow up after 10 weeks
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No current identification of the amniotic band.
Diffuse turbid amniotic fluid.
Initial Doppler examination revealed:
- diastolic flow reversal of middle cerebral artery (MCA)
- higher resistive waveform of umbilical artery (UA) for gestational age
Repeated Doppler examination at the same setting revealed:
- Normal Doppler waveform of umbilical artery (UA) and middle cerebral artery (MCA)
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This case shows a free-floating thread with an intact chorionic membrane, representing an amniotic band. It can lead to amniotic band syndrome. So, careful examination of fetal limbs is necessary.
Differential Differential diagnosis is amniotic sheetwhich is a shelf-like indentation of the amniotic sac made by uterine synechia. It is, not associated with fetal anomalies.
Amniotic band can resolve spontaneously during pregnancy with no fetal harm 1.
Middle cerebral artery Doppler can occasionally show diastolic flow reversal, a non-pathological finding that is usually due to increased intracranial pressure mostly by probe compression 2,3.
Echogenic/turbid amniotic fluid is reported to occur in ~4% of first and second-trimester ultrasound examinations 4.
-<p>This case shows a free-floating thread with an intact <a href="/articles/chorion">chorionic membrane</a>, representing an <a title="Amniotic bands" href="/articles/amniotic-bands">amniotic band</a>. It can lead to <a href="/articles/amniotic-band-syndrome">amniotic band syndrome</a>. So, careful examination of fetal limbs is necessary.</p><p>Differential diagnosis is <a title="Amniotic sheet" href="/articles/amniotic-shelf">amniotic sheet</a><strong> </strong>which is a shelf-like indentation of the amniotic sac made by uterine synechia. It is not associated with fetal anomalies.</p>- +<p>This case shows a free-floating thread with an intact <a href="/articles/chorion">chorionic membrane</a>, representing an <a href="/articles/amniotic-bands">amniotic band</a>. It can lead to <a href="/articles/amniotic-band-syndrome">amniotic band syndrome</a>. So, careful examination of fetal limbs is necessary. Differential diagnosis is <a href="/articles/amniotic-shelf">amniotic sheet</a><strong> </strong>which is a shelf-like indentation of the amniotic sac made by uterine synechia, not associated with fetal anomalies.</p><p><a title="Amniotic bands" href="/articles/amniotic-bands">Amniotic band</a> can resolve spontaneously during pregnancy with no fetal harm <sup>1</sup>.</p><p><a title="Fetal MCA Doppler assessment" href="/articles/fetal-middle-cerebral-arterial-doppler-assessment">Middle cerebral artery Doppler</a> can occasionally show <a title="Middle cerebral artery end diastolic flow reversal" href="/articles/middle-cerebral-artery-end-diastolic-flow-reversal">diastolic flow reversal</a>, a non-pathological finding that is usually due to increased intracranial pressure mostly by probe compression <sup>2,3</sup>. </p><p><a title="Echogenic amniotic fluid" href="/articles/echogenic-amniotic-fluid">Echogenic/turbid amniotic fluid</a> is reported to occur in ~4% of first and second-trimester ultrasound examinations <sup>4</sup>.</p>
References changed:
- 1. Pedersen T, Pedersen TS, Pedersen. Spontaneous Resolution of Amniotic Bands. (2001) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. <a href="https://doi.org/10.1046/j.0960-7692.2001.00478.x">doi:10.1046/j.0960-7692.2001.00478.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11844214">Pubmed</a> <span class="ref_v4"></span>
- 2. Brownfoot FC, Cluver CA, Walker SP. Persistent reversed end diastolic flow in the fetal middle cerebral artery: an ominous finding. (2015) Ultrasound (Leeds, England). 23 (3): 186-9. <a href="https://doi.org/10.1177/1742271X15587600">doi:10.1177/1742271X15587600</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27433256">Pubmed</a> <span class="ref_v4"></span>
- 3. Respondek M, Respondek WA, Respondek KP, et-al. Reversal of Diastolic Flow in the Middle Cerebral Artery of the Fetus During the Second Half of Pregnancy. (1997) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. <a href="https://doi.org/10.1046/j.1469-0705.1997.09050324.x">doi:10.1046/j.1469-0705.1997.09050324.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9201876">Pubmed</a> <span class="ref_v4"></span>
- 4. Kaluarachchi A, Jayawardena GRMUGP, Ranaweera AKP, et-al. Hyperechoic amniotic fluid in a term pregnancy. (2018) Journal of Family Medicine and Primary Care. 7 (3): 635. <a href="https://doi.org/10.4103/jfmpc.jfmpc_83_18">doi:10.4103/jfmpc.jfmpc_83_18</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30112323">Pubmed</a> <span class="ref_v4"></span>
- 4. Kaluarachchi A, Jayawardena GRMUGP, Ranaweera AKP, et-al. Hyperechoic amniotic fluid in a term pregnancy. (2018) Journal of Family Medicine and Primary Care. 7 (3): 635. <a href="https://doi.org/10.4103/jfmpc.jfmpc_83_18">doi:10.4103/jfmpc.jfmpc_83_18</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30112323">Pubmed</a> <span class="ref_v4"></span>
- 4. Kaluarachchi A, Gardie Role Malwattage Udara Ganthika Peiris Jayawardena, et-al. Hyperechoic amniotic fluid in a term pregnancy. (2018) Journal of Family Medicine and Primary Care. 7 (3): 635. <a href="https://doi.org/10.4103/jfmpc.jfmpc_83_18">doi:10.4103/jfmpc.jfmpc_83_18</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30112323">Pubmed</a> <span class="ref_v4"></span>
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