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Amniotic Band Syndrome

Manish Narang, Sumaira Khalil and M.M.A. Faridi
Department of Paediatrics, University College of Medical Sciences and GTB Hospital, Delhi, India

This four month old male child, presented with chief complaints of multiple constrictive rings in both upper and lower limbs (Fig. 1). Two antenatal ultrasounds done at 18 weeks and 36 weeks were totally normal and failed to detect these abnormalities. The child was totally asymptomatic and the abnormality was noticed by the parents. The maternal obstetric history was not suggestive of any insult in the antenatal period.

from the chorionic side of the amnion, followed by disruption. It has been suggested that the bands lead to a decreased blood flow in the constricted limb and subsequent natural amputation. The timing of rupture is believed to occur between 28 days after conception to 18 weeks of gestation.1 However, late bands can occur and present at birth with multiple abnormalities of the limb, even after a normal sonogram earlier. They are difficult to detect on the ultrasound and are more often diagnosed by their effect on the growing fetus. The complications in the amniotic band syndrome can range from constriction rings of finger to amputation of fingers, or syndactyly of fingers and toes. The association of anomalies like club feet, gastroschisis, omphalocele, bladder exstrophy and imperforate anus should arouse the suspicion of amniotic band.2 The differential diagnosis could include amniotic folds, short umbilical cord, and extra amniotic pregnancy.3 It is extremely unlikely that amniotic bands will affect a future pregnancy. REFERENCES

Fig. 1. Constriction rings and ampulated toes of amniotic band syndrome

This child had amniotic band syndrome which is a rare condition caused by strands of amniotic sac that separate and entangle digits, limbs or other parts of the fetus. Rupture of the amnion leads to entrapment of fetal structures by sticky mesodermic bands that originate

1. Walter JH, Goss LR, Lazzara AT. Amniotic Band Syndrome. J Foot and Ankle Surgery 1998; 37 : 325-333. 2. Burton DJ, Filly RA. Sonographic evidence of Amniotic band syndrome. Am J Roentgenol 1991; 156 : 555-558. 3. Verma A, Mohan S, Kumar S. Late presentation of Amniotic band syndrome. J Clinical and Diagnostic Research 2007; 1 : 6568.

Correspondence and Reprint requests : Dr. Manish Narang, Lecturer, U.C.M.S. and G.T.B.Hospital, Dilshad Garden, Delhi110095. , Email: manish_2710@yahoo.com, Tel No 09811036569 [Received November 5, 2007; Accepted January 4, 2008]

Indian Journal of Pediatrics, Volume 75July, 2008

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