Amniotic Band Syndrome: Is There Anything We Can Do In The Underdeveloped Countries Of Sub-Saharan Africa? Report Of 3 Cases And Literature Review

Amniotic band syndrome or sequence (ABS) is a fetal congenital malformation, mainly affecting limbs and mostly characterized by digital amputations and constrictions rings due to fibrous amniotic bands (AB). It can also affect the craniofacial area and internal organs. Two main pathological mechanisms have been proposed amnion rupture (exogenous theory) leading to fibrous bands, which wrap up the fetal body; endogenous theory which is of vascular origin resulting in the failure of development of embryo. This second theory can explain the occurrence of disease when no amnion rupture is observed. The outcome of the disease during pregnancy depends on the severity of the malformations. Termination of pregnancy is usually considered when severe abnormalities were diagnosed. In-utero lysis of bands, by laser application, is sometimes done before amputation, for isolated amniotic band with a constricted limb. Such treatment is not possible in the underdeveloped countries of sub-Saharan Africa in view of suboptimal antenatal diagnosis. The disease is often discovered only in newborn. Minor limb defects can be repaired with postnatal surgery. However overall prognosis of ABS in the underdeveloped countries of sub-Saharan Africa is often poorer. Our 3 cases illustrated these points.