Case Notes
A 27-year-old pregnant woman, gravida 1, was referred to our fetal surgery center because of amniotic band (AB) syndrome at 15 5/7 weeks’ gestation. Fetal ultrasound showed distal edema of the right foot and ABs around the left hand and umbilical cord. With local maternal anesthesia, a percutaneous transabdominal fetoscopy was performed at 16 weeks using a 1.0-mm fetoscope. Constriction rings with tight AB wrapped around the fingers of the left hand ( Figure 1 ), right foot ( Figure 2 ), and umbilical cord ( Figure 3 ) were observed during fetoscopy. All ABs were successfully released from the hand, foot, and umbilical cord ( Figure 4 ) using a diode laser with a 400-μm fiber at 15W. No complications occurred during fetal intervention. At 30 weeks’ gestation, the patient underwent cesarean delivery after premature rupture of membranes. After 1 week of mechanical ventilation, the baby survived and is doing well at 2 years of age without limb amputation but with amputation of the right toes ( Figure 5 ). Fetal ABs are a condition that can involve fetal structures leading to vascular obstruction encompassing a spectrum of manifestations including limb amputation and intrauterine death by cord constriction. Early release of AB at 16 weeks’ gestation with a 1.0-mm fetoscope is feasible and may improve neonatal survival and rescue limb function.
