The oviduct - beneficial as well as deadly

The oviduct is one of the foetal membranes that are formed from the so-called embryonic cotyledons in early prenatal life. There are three types of amniotic membrane according to the location in which it occurs - the first directly covering the foetal bladder, the second covering the placenta and the third forming the umbilical amniotic membrane. The amniotic membrane surrounds the foetus, forming a foetal bladder filled with amniotic fluid. It is the fluid - also called amniotic fluid - that creates the environment for intrauterine development, protects the developing foetus from drying out, and insulates it from external stimuli. In extreme cases, when the amniotic sac ruptures, the amniotic fluid also begins to play a negative role - its bands, called bands, can cause significant problems for the developing baby.

What is amniotic band syndrome?

Amniotic bandsyndrome is classed as a congenital condition that arises during the prenatal period. It is known by a number of names - amniotic bands, amniotic bands, Simonart bands, or ammonitic band syndrome. The condition manifests itself as premature rupture of the amniotic sac, with consequent damage to the tissues that come into contact with the amniotic bands or bands. Strips of connective tissue from the amniotic sac stick to various parts of the developing baby's body. By wrapping around the baby's tissues, the bands cause a kind of 'trap' for the growing baby. For example, the bands surrounding the hand can lead to anaemia, oedema and, as a consequence, spontaneous amputation of the hand. The same is true of other tissues - chest, abdomen, legs, feet or hands. Amniotic bands also cause spina bifida, cerebral hernia, meningo-spinal hernia. In cases where the developing baby swallows an amniotic band, a cleft palate or facial cleft can result. In extreme cases, amniotic band syndrome can lead to the death of the developing baby - especially if the bands have wrapped the head, neck or umbilical cord.

Who is most at risk of developing amniotic band syndrome?

There is no clear answer to this question. Doctors agree - the causes of the syndrome are unknown. Perhaps the reasons lie in genetic defects, abnormal cell divisions, traumatic experiences of the mother - but there is no conclusive evidence to support any of these theses. Doctors agree that rupture of the amniotic sac most commonly occurs between the twenty-eighth day after conception and the eighteenth week of pregnancy. However, there are reports in the literature, of the appearance of amniotic bands at later stages of pregnancy, despite previous normal test results.

Amniotic band syndrome, photo: shutterstock

What can amniotic band syndrome result in?

Amniotic band syndrome can cause, among other things:

• abnormal development of the motor organs (legs, arms) or their components (hands, feet, fingers),
• amputation of limbs,
• amputation of developing tissue elements,
• spina bifida,
• cleft palate,
• in extreme cases, death.

Prevention

The occurrence of amniotic band syndrome cannot be prevented. Hence the doctors' appeal not to underestimate routine, follow-up Medical US examinations during pregnancy. Every pregnant woman should undergo a Medical US examination once every four weeks. Already during prenatal examinations at the twelfth week of pregnancy, doctors can observe signs of amniotic band syndrome. Doctors are required to verify, for example, the number of fingers and toes and check the normal development of the baby. Importantly, another examination to confirm normal development is the Medical US genetic examination of the second trimester, called the mid-term, when the doctor once again checks for the correct development of the arms, legs, feet, hands but also internal organs. Doctors agree that it is extremely difficult to observe the amniotic band syndrome and a specialised, modern Medical US apparatus is needed for this. It is therefore advisable to choose specialists who have modern equipment and are certified in their skills.

What should be of concern on a Medical US image?

As the specialists at Seattle Children's hospital point out, the main things that should be of concern on a Medical US image are:

• irregular folds and indentations around the fingers, hands, feet, arms,
• strange swelling of the limbs,
• difference in length of arms/legs,
• a cleft in the craniofacial or visceral region, chest or back.

What if amniotic band syndrome is observed?

There is no single golden remedy. Doctors recommend observing the baby's development, more frequent Medical US visits. Some doctors advise carrying out additional tests involving a small dose of X-rays (X-rays) to exclude progressive amputation of the organs of movement. In addition, some research centres recommend an MRI - magnetic resonance imaging (MRI), which will allow the condition of the vessels - the veins and arteries that line the amniotic bands - to be analysed in detail. Sometimes, in extreme cases, intrauterine surgery is carried out to 'free' the baby's tissues from the bands. The choice of the size and extent of the operation, depends on how much the amniotic bands are encasing the baby's tissues. Usually, the operation involves making delicate incisions above and below the band, which ties up the healthy tissue, and 'freeing' the tissue from swelling. In some cases, where surgery is not indicated in foetal life, procedures to reconstruct damaged tissue take place after the baby is born - these include bone plication, skin surface plication, prosthetics to replace limbs amputated during foetal life.