Amniotic Band Syndrome (Streeter Dysplasia) Workup

Updated: Sep 10, 2020
  • Author: Twee T Do, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Workup

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).

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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.

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Procedures

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

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