Amniotic constrictions: causes, symptoms, treatment regimen and diagnosis

Sometimes clinically healthy mothers are born children with morphological defects: the lack of phalanges of the fingers, limbs and even the head. Mothers come in despair, reproach themselves or doctors for what happened to their child. Sometimes it comes to litigation. But what really is the cause of these birth defects?

Definition

Amniotic constrictions, otherwise called "amniotic fusion" or "strands of Simonar," are a duplicate of the tissue of the amnion, which is stretched between the walls of the uterus. As a rule, it does not harm the embryo and does not present complications in childbirth. But in rare cases, serious consequences are possible.

Amniotic constrictions are fibrous strands that arise in the fetal bladder. They can squeeze or bandage the umbilical cord, attach to parts of the fetal body, causing developmental defects (amputation of hands, feet, fingers or their phalanges, sometimes decapitation).

Causes

There are two theories, why there are amniotic constrictions. The causes of this phenomenon are explained by frequent ruptures of the amniotic bladder in the early stages of pregnancy. Since the chorion remains intact, there is no threat of interruption of the development of the embryo, but the threads that arise due to ruptures freely float in the amniotic fluid. They can be attached to parts of the fetal body. With the course of pregnancy the child grows, but the strands remain the same as they were, so there is compression of the tissues, ischemia and necrosis.

Some time later a second theory appeared, since the first did not suit skeptics who noticed that amniotic constrictions (fibrous strands in the abdomen of a pregnant woman) appear simultaneously with other congenital malformations, such as a hare lip or wolf mouth. These doctors had the assumption that the cords arose because of vascular disorders or circulatory disorders of the fetus.

Another variant of the development of events is intrauterine infection, as well as trauma during pregnancy, anomalies of the genitals (doubling of the uterus, bicornic uterus , etc.), ICN (ischemic-cervical insufficiency), inflammation of the amnion, endometritis, and water scarcity. But none of these theories is not confirmed definitively.

Diagnostics

In most cases, clinically and laboratory it is not possible to detect amniotic constrictions. Photos from ultrasound studies are not informative, as these threads are very thin. Indirectly, you can identify enlarged and swollen limbs in the areas of compression. The overdiagnosis of this pathology is largely prevalent. Therefore, if a doctor suspects having amniotic cords, the pregnant woman is sent to an MRI or 3D ultrasound.

More than half of the diagnosed amniotic constrictions on repeated ultrasound are not detected because of their rupture.

Statistics

Depending on the technical equipment of the female consultation, the frequency with which the amniotic constrictions are detected can range from 1: 1200 to 1:15 000 births. It is estimated that two out of ten thousand miscarriages occur precisely for this reason. In eighty percent of cases, Simonard's strings deform the fingers and hands, and another ten percent is the compression of the umbilical cord. It is the formation of nodes on the umbilical cord leading to hypoxia and antenatal fetal death.

Fortunately, most diagnoses of "amniotic constriction syndrome" are not clinically confirmed, or fibrous filaments do not cause significant damage to the fetus.

Heredity

The likelihood that amniotic constrictions will appear during pregnancy is extremely small. This is not a hereditary disease. As a rule, genomic or chromosomal mutations are manifested symmetrically, and in this case the filaments are attached absolutely randomly. If, during the first pregnancy, Simonar's strings were observed in the child, this does not mean that subsequent children will be injured. Also, this does not mean that a child with developmental defects will be born from parents who have in utero suffered the syndrome of amniotic constrictions.

Effects

Although amniotic constriction is not a fatal pathology, its consequences are very depressing. Due to the fact that strands can entangle parts of the fetal body, lymphatic stasis develops. This leads to edema and necrosis. After birth, such extremities should be amputated, otherwise the CRUSH syndrome will develop: toxins that accumulate in the narcotized part of the limb, get into the systemic bloodstream and begin to poison the baby's organs. This can lead to his death. Therefore, it is necessary to remove the limb if it is not viable. And as soon as possible.

In addition, with the syndrome of amniotic constrictions, the limbs and fingers can be pressed into the proximal part of the limb. There are often among such children the fusion of the fingers or the phalanges of the fingers and toes. Sometimes, in addition to constrictions, the child has other stigmata of disembriogenesis: cleft palate of the hard palate and upper lip. In very rare cases, there are gross violations of the development of the spine and facial skull, the eutivation of the abdominal cavity organs, the atresia of the umbilical cord.

If the constriction affects closely located vessels to the skin, then this place is formed hemangioma. A tumor after birth will need to be removed.

Some scientists find the connection between the strings of Simonard and the clubfoot. This is because the legs of the fetus are fixed with fibrous threads, so the walls of the uterus can squeeze the foot of the fetus. In twenty percent of cases, this pathology is bilateral. Another risk that an obstetrician-gynecologist should provide is premature birth. This complication is not uncommon in pregnancies that occur with the amniotic constipation syndrome.

Treatment

As a rule, in utero this disease is not treated. In medical practice, there are casuistic cases when transvaginal or laparoscopic operations were performed. But this was an extreme measure, since the vital organs were squeezed. But this is an extremely rare amniotic constriction. Treatment, as a rule, is carried out after the birth of the child.

Fibers dissect and, if necessary, amputate part of the limb. To improve the quality of life, you can turn your fingers up and down.

Forecast

The prognosis for life and health is usually favorable. Children in most cases grow and develop according to their age. Every year limb prostheses are improved, so if you lose your forearm, hand, shin, or foot, you can put an artificial replacement. Children are advised to change the prosthesis as they grow up. If the constrictions have caused a slight functional defect, the cosmetic defect can be eliminated by transplanting the fingers, as well as their phalanges.

People with amniotic constipation syndrome can have completely healthy children, since this disease is not inherited.

Celebrities who had the strings of Simonar

The time has already passed when people with amputation of limbs hid in their homes and were ostracized by the community. Now they can live practically without restrictions, occupy important public posts, play sports, act on television and participate in beauty contests.

Some famous people do not hesitate to be born with congenital amputations, but whether this happened because of amniotic constrictions is an open question.

1. Carrie Burnell is an actress who was born without a right forearm. She works on a children's TV channel. This caused a mixed response among the small spectators and their parents and served as an impetus to the appearance of a series of programs on how to tell children about the disability and the characteristics of the lives of such people.
2. Jim Abbott is familiar to all baseball fans. He is a legendary pitcher, that is, a serving, without a right hand. He left the big sport at the end of the twentieth century, but his example continues to inspire many disabled people and Paralympians.
3. Teresa Yukatil - the beauty of Miss America, was born without a left hand. During the competitions did not wear a prosthesis to show that you can be beautiful and without artificial details.
4. Kelly Knox is the top model without a left forearm. In 2008, she became the winner of the reality show on the BBC 3. In addition to her, seven other girls with various injuries participated in the competition.
5. Nicholas McCarthy is a famous pianist who was born without a right hand.
6. Nicholas Vuychich is an Australian, a Christian preacher. Known for being born without all limbs. He releases his books and travels with seminars around the world as an example of the fact that one should not give up even in the most difficult situations.
7. Mark Goffeni is a guitarist born with amputated hands. He learned to play with his toes.