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Re: chorioamniotic separationFrom: art fougner, md (evsono@pipeline.com)Mon Jan 4 10:21:48 1999
Dear Dr. Hsu i fear i spoke too soon - here's a mixed bag of abstracts concerning CAS. Fetal Diagn Ther 1997 Mar-Apr;12(2):81-4 Chorioamniotic membrane separation: a potentially lethal finding. Graf JL, Bealer JF, Gibbs DL, Adzick NS, Harrison MR Department of Surgery, University of California, San Francisco, USA. jgraf@itsa.ucsf.edu Sonographic detection of chorioamniotic membrane separation (CMS) has been considered a benign incidental finding. We now report 6 cases of CMS identified by prenatal ultrasound; 1 in an otherwise normal pregnancy and 5 following fetal surgery. Following membrane separation, amniotic bands formed and compromised the umbilical cord in 4 cases leading to 2 fetal deaths. In the first case, CMS was detected by ultrasound at 22 weeks' gestation in an otherwise uncomplicated pregnancy. Because CMS was considered benign and umbilical cord blood flow was ample, the mother was followed by intermittent sonographic examinations. Fetal demise occurred 2 weeks later, clearly due to umbilical cord strangulation by an amniotic band. Surprised by this unexpected outcome, we reviewed our experience with CMS after hysterotomy for fetal surgery. Out of more than 40 fetal surgical cases, we have 5 cases in which CMS was recognized after hysterotomy. Three of these fetuses had umbilical cord compromise by a band of amniotic membrane leading to 1 fetal death. This experience demonstrates that membrane separation may be associated with amniotic band formation which can lead to cord strangulation and fetal compromise. Following fetal surgery, serial ultrasound evaluation and close fetal monitoring are indicated. In otherwise unremarkable pregnancies, clinician awareness of the possibility of amniotic band formation following CMS should be heightened. In either situation, knowledge of this potential life-threatening complication may identify cases in which cord compromise requires emergent delivery or fetoscopic release of the strangulating amniotic band. Radiology 1998 Oct;209(1):175-81 Chorioamniotic separation after second-trimester genetic amniocentesis: importance and frequency. Levine D, Callen PW, Pender SG, McArdle CR, Messina L, Shekhar A, Wong GP Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. PURPOSE: To determine the frequency and importance of chorioamniotic separation (CAS) after second-trimester genetic amniocentesis. MATERIALS AND METHODS: In part 1 of the study, ultrasonography (US) databases were reviewed for cases of CAS. In part 2, a study population of 388 women undergoing amniocentesis underwent directed US examination for assessment of CAS 15 minutes and/or 2 weeks after amniocentesis. CAS, when present, was graded. A control population consisted of 363 women undergoing amniocentesis in whom the membranes were not assessed. RESULTS: In part 1, a review of 23,883 records revealed seven cases of complete CAS, with three deaths, two preterm deliveries, and one emergency cesarean section delivery due to fetal distress. In two of these cases, there were extremity deformities at birth. In part 2, CAS was present in 98 (25%) of 388 women at some point. There was no association between CAS and procedural variables. There was no substantial difference in morbidity between patients with and those without CAS, between patients with different grades of CAS, or between the study and control populations. CONCLUSION: Small degrees of CAS are frequently present after amniocentesis but are not detected because the membranes are not specifically evaluated. Complete CAS is less frequent. JCU J Clin Ultrasound 1982 Jan;10(1):1-8 Intrauterine membranes: sonographic findings and clinical significance. Burrows PE, Lyons EA, Phillips HJ, Oates I We have identified six cases of chorioamniotic separation, three diagnosed in the third trimester and three cases seen in early pregnancy, at or prior to 16 wk' gestation. The sonographic findings consist of a fine mobile echodense line separated from the chorion and uterine wall by a lucent space. The membrane may completely surround the fetus and may extend over the fetal surface of the placenta, in which case the chorion may be identified as a separate echo. Two patients with chorioamniotic separation in the third trimester had polyhydramnios. The infants had no manifestations of amniotic band syndrome. The membranes seen in four other conditions are described and compared with chorioamniotic separation. at present, would suggest follow-up studies and if necessary, appropriate referral for a Maternal-Fetal Medicine consult. good luck Art
At Mon, 4 Jan 1999, J. Hsu wrote:
>
-- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com
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