Laboratory Studies

Because amniotic band syndrome (ABS; also referred to as amniotic band sequence or Streeter dysplasia) is an extrinsic yet spontaneous phenomenon, no good laboratory tests exist to detect its presence. Levels of α-fetoprotein have been shown to be elevated with normal acetylcholinesterase activity, but this elevation may be due to the anencephaly (with positive acetylcholinesterase isoenzymes) or fetal demise (negative acetylcholinesterase isoenzymes).

Imaging Studies

Serial ultrasonograms can show the gross lack of formation, such as anencephaly or intrauterine amputations, but earlier ultrasonographic (US) studies of monozygotic twins were disappointing.^[26]One study reported evidence of ABS on US in both twins, but only one twin had clinical manifestations (and those were severe).

Advances in US technology and the availability of three-dimensional (3D) and four-dimensional (4D) US have allowed the defect to be characterized down to the level of how the nerves and muscles are affected distally.^{[27, 28, 29]}The greater level of detail now available has made US a more reliable resource for identifying this disorder early in gestation, thereby allowing better prediction of the ultimate fetal prognoses.^{[30, 31, 14]}This, in turn, may affect the outcome of antenatal counseling regarding the pregnancy. Antenatal diagnosis of atypical facial clefting should alert physicians to the possibility of ABS and other anomalies.^{[32, 33]}

Magnetic resonance imaging (MRI) may be considered preoperatively on limbs with deep bands to evaluate the neurovascular status.^[34]Magnetic resonance angiography (MRA) of limbs affected by ABS may reveal vessel deficiencies and variable anatomy that could affect the surgical outcome.

Procedures

Amniocentesis has been associated with membrane rupture after needle placement. Therefore, it has no significant place in the diagnosis or treatment of ABS.

Treatment & Management

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Media Gallery

Image shows the lower limb of a young child born with moderate bands that extend deep to the fascia but do not compromise the neurovascular system.

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Author

Twee T Do, MD Clinical Faculty, Rocky Vista University College of Osteopathic Medicine; Attending Surgeon, Advanced Orthopedics

Twee T Do, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, Colorado Medical Society, Scoliosis Research Society, Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

George H Thompson, MD Director of Pediatric Orthopedic Surgery, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, and MetroHealth Medical Center; Professor of Orthopedic Surgery and Pediatrics, Case Western Reserve University School of Medicine

George H Thompson, MD is a member of the following medical societies: American Orthopaedic Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons

Disclosure: Received none from OrthoPediatrics for consulting; Received salary from Journal of Pediatric Orthopaedics for management position; Received none from SpineForm for consulting; Received none from SICOT for board membership.

Chief Editor

Jeffrey D Thomson, MD Professor of Orthopedic Surgery, University of Connecticut School of Medicine; Director of Orthopedic Surgery, Connecticut Children’s Medical Center; Vice President of Medical Staff, Connecticut Children's Medical Center

Jeffrey D Thomson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, Scoliosis Research Society

Disclosure: Nothing to disclose.

Additional Contributors

Charles T Mehlman, DO, MPH Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association

Disclosure: Nothing to disclose.