One sided upper extremity amputation related to amniotic band syndrome: a case report

Amniotic band syndrome anomalies is a syndrome that is caused premature rupture of amniotic membranes and results a broad spectrum of fetal anomalies. Syndrom can result various anomalies in a wide spectrum caused by a simple band construction, ranging from major craniofascial visceral defects and fetal demise. In this syndrome various malformations can be seen but most effected parts are extremities.Prognosis is related to severity of anomalies and involvement of the organs.
19 years old, gravisy 1, parity 0, 16 weeks pregnant patient according to the last menstrual period was referred to our clinic because of non visulation of right upper extremity. There was no significant features in the patient's history. Ultrasonographic measurements of gestation was consistent with gestational age. She had no history of previous operation and additional systemic disease.There was no history of consanguineous marriage and drug use. First trimester screening test was not avaliable. There was not sufficient information about first-trimester nuchal thickness on the 11-14 week scan. In the fetal anatomical scan, on the right upper extremity distal radius and ulna were observed absent from ½ part. The left upper extremity and both lower extremities were normal. Fetal echocardiographic examinations were normal. In anatomical scan no additional anomalies were detected. The patient was recommended to karyotyping and amniotic fluid sampling for prenatal diagnosis by amniocentesis was performed. Without waiting the result of karyotyping, the case was discussed in the council and she were offered the option of pregnancy termination. With the request of the patient, pregnancy was terminated vaginally. At the macroscopic appearance of abortion material,the ½ part of distal radius and ulna on the right extremity were amputated. At the right forearm amputation level, a thin amniotic membrane fold that could not be visualised on ultrasound was observed that was wraping right forearm very hard and the other part of it was attached to left parietal bone on cranium and that caused a 3-4mm defection cranium. Any other gross anomalies was not observed. Fetal amniotic band was confirmed in the autopsy examination and the diagnosis of the right forearm amputation due to the amniotic band syndrome was confirmed. In amniotic band syndrome complications of upper and lower extremities are frequently observed but may also cause visceral anomalies. Amniotic bands are structures that are very difficult to be select on the ultrasound but can be determined in case of detection of abnormalities of the extremities with a more careful examination. But like in our case, an amniotic band that is so tightly wraping the limb may not be displayed in ultrasonography. Like in our case, other cranial structures and organs can have deformations together with limb amputations by the advancement of gestational age.

Keywords

Amniotic band syndrome, fetal amputation

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	File/Dsecription
	Figure 1 Postabortion x-ray image of fetus
	Figure 2 Ultrasonographic image of amputed extremity radius
	Figure 3 Amputed upper extremity and amniotic band