Fetoscopic Amniotic Band Release in a Case of Chorioamniotic Separation: An Innovative New Technique

Abstract

A 28-year-old gravida 1 para 0 patient was referred to the Fetal Center at Texas Children's Hospital at 19 weeks of gestation due to the suspicion of preterm premature rupture of the membranes (PROM) and extensive chorioamniotic membrane separation. An amniotic band syndrome was also noted involving the left ankle, the infrapatellar region Keywords ► fetus ► amniotic band ► CO 2 ► 2-port ► simplified closure Abstract Introduction Fetoscopic release of amniotic bands has proved its life-and limb-saving potential. Rupture of the amnion and separation of chorion from the amnion and uterine wall can however preclude the standard fetoscopic approach to release the amniotic bands using a single port. Methods and Materials A 28-year-old G1P0 woman was referred to our unit at 19 weeks due to amniotic band syndrome involving the left ankle, the infrapatellar region of the right leg, and the umbilical cord. Of note, part of the fetus was seen outside the amniotic cavity by ultrasonography and the left ankle and foot were severely swollen. The patient underwent a laparotomy and fetoscopic release of the amniotic bands as well as partial amnionectomy using two uterine ports and CO 2 as distention. Results The surgery and postoperative recovery course were uneventful. At 341/7 weeks the patient went into labor, which was augmented resulting vaginal delivery of a 2,460-g male infant. The infant was noted to have a shallow skin indentation on the left lower extremity near the ankle. The infant was discharged in excellent condition. Conclusion In those cases where release of an amniotic band is impossible due to membrane separation, surgery in a CO 2-filled uterus offers an option.