Abstract：
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: This is a case report, alongside a review of the literature.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: This is a case report, alongside a review of the literature.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：羊膜带是一种罕见的疾病，可导致结构性肢体异常，胎儿窘迫和不良产科结局。其病因的主要假设是妊娠早期羊膜破裂，在胎儿周围形成紧密缠绕的链。这些线可以收缩，切斯,随后截肢，颈部或头部。很少,羊膜带可以影响脐带，导致胎儿宫内窘迫或潜在的胎儿死亡。
目的：我们介绍了一个26周孕妇的独特案例，该孕妇因胎儿运动减少而参加了多临床会诊，并伴有有关心脏造影（CTG）的发现。还对有关脐带羊膜带的文献进行了回顾，为产科医生的实践确定诊断和介入选择。
方法：这是一个病例报告，以及对文献的评论。
结果：CTG提示胎儿宫内窘迫，提示紧急剖腹产（剖腹产）。交付时，新生儿表现出羊膜带序列的迹象，右手指骨远端缺损，羊膜束导致脐带严重收缩，后者导致胎儿缺氧。在没有截肢的情况下，直接超声诊断仍然是一个挑战，然而，如远端肢体或脐多普勒血流异常和远端肢体水肿等间接征象可能提示羊膜带。MRI被提议作为辅助诊断工具，但与超声相比，它没有更高的检出率。文献中已经描述了进行羊膜链裂解的胎儿镜手术，结果良好。
结论：该病例首次报道了因脐带羊膜扎带引起的缺氧窘迫的极度早产胎儿的存活率，罕见的偶然时机。超声诊断仍然是金标准。产科警惕是必要的，胎儿抢救被证明是可行的。
目的：我们介绍了一个26周孕妇的独特案例，该孕妇因胎儿运动减少而参加了多临床会诊，并伴有有关心脏造影（CTG）的发现。还对有关脐带羊膜带的文献进行了回顾，为产科医生的实践确定诊断和介入选择。
方法：这是一个病例报告，以及对文献的评论。
结果：CTG提示胎儿宫内窘迫，提示紧急剖腹产（剖腹产）。交付时，新生儿表现出羊膜带序列的迹象，右手指骨远端缺损，羊膜束导致脐带严重收缩，后者导致胎儿缺氧。在没有截肢的情况下，直接超声诊断仍然是一个挑战，然而，如远端肢体或脐多普勒血流异常和远端肢体水肿等间接征象可能提示羊膜带。MRI被提议作为辅助诊断工具，但与超声相比，它没有更高的检出率。文献中已经描述了进行羊膜链裂解的胎儿镜手术，结果良好。
结论：该病例首次报道了因脐带羊膜扎带引起的缺氧窘迫的极度早产胎儿的存活率，罕见的偶然时机。超声诊断仍然是金标准。产科警惕是必要的，胎儿抢救被证明是可行的。
