Limb amputation secondary to pseudoamniotic band syndrome
Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication that occurs after invasive procedures in monochorionic twins for treatment of twin-twin transfusion syndrome (TTTS). Published in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology, the authors report a case of a monochorionic biamniotic twin pregnancy submitted to SFLP for TTTS at 19 weeks of gestation with postnatal diagnosis of PABS, presenting with amputation of a fetal limb.

A 34-years-old woman, gravida 2, para 1, was referred at 9 weeks of gestation for spontaneous monochorionic biamniotic twin pregnancy. At 12 weeks of gestation, twins presented slightly discordant crown-rump lengths, but concordant amniotic fluid indexes with nuchal translucencies of 1.18 and 0.76 mm and normal Ductus Venosus. An ultrasound performed at 17 weeks of gestation revealed Quintero stage II TTTS.

After counseling, parents decided to submit to SFLP of vascular anastomosis. The procedure took place at 19 weeks in a referral center and no complications were noticed. Before the procedure, a normal morphology of the twins was confirmed. In postoperative surveillance, no signs of recurrent TTTS were noticed and no fetal morphologic abnormalities were detected. Subsequent sonographic examinations revealed growth restriction of the donor, with concordant fluid indexes and normal umbilical artery flows.

At 27 weeks of gestation, pregnancy was complicated with a preterm rupture of membranes. A cesarean section was decided at 29 weeks and 6 days of gestation for severe growth restriction with abnormal flow in the umbilical artery. A 1125g girl (recipient) with Apgar scores at 1st and 5th minutes of 8/9 and a 475g girl (donor) with Apgar scores at 1st and 5th minutes of 6/8 were delivered. After birth, physical examination showed amputation of the left hand of the donor with necrotic stumps of left-hand fingers still attached to the arm.

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