Separation of amniotic membranes after amniocentesis in an individual with the classic form of EDS and haploinsufficiency forCOL5A1 expression

Outcomes of prenatally diagnosed spontaneous chorioamniotic membrane separation in singleton pregnancies: A systematic review of case series and case reports

OBJECTIVES

To provide an overview of perinatal outcomes in prenatally diagnosed spontaneous chorioamniotic separation (sCAS).

METHODS

A systematic search of the literature was performed from inception to July 2019, including PubMed, Ovid MEDLINE, and Ovid EMBASE. All studies reporting prenatally diagnosed sCAS after 16 weeks' gestation in singleton pregnancies were eligible. Two independent reviewers used standardized forms for data abstraction.

RESULTS

Of 408 screened abstracts, 17 studies reporting 118 cases of sCAS were included. Among 113 cases with delivery outcomes, preterm birth (PTB) occurred in 60 (53.1%, 95% confidence interval [CI] 43.9-62.3%). Intrauterine fetal demise (IUFD) occurred in seven (6.2%, 95% CI 1.8-10.6%) cases, with four due to cord strangulation. Spontaneous abortion occurred in one (0.88%, 95% CI -0.84-2.6%) case. Among 104 cases with postnatal follow-up, there were six (5.8%, 95% CI 1.3-10.3%) neonatal deaths and one (0.96%, 95% CI -0.91-2.8%) infant death. Perinatal mortality (IUFD and neonatal deaths) was 11.0% (95% CI 5.4-16.7%).

CONCLUSIONS

sCAS may be associated with increased risk of PTB, however, the available data are largely case reports and series. Antepartum surveillance after viability can be considered due to risk of cord accidents. Prospective study is necessary to understand the clinical implications of sCAS.

Prenatal sonographic assessment and perinatal course of ichthyosis prematurity syndrome

All cases of ichthyosis prematurity syndrome (IPS), registered at the National Center for Fetal Medicine in Trondheim, Norway between 1987 and 2010 were identified and the findings analyzed. Five fetuses with IPS were identified between 1988 and 2000. All five developed polyhydramnios between 28 and 31 weeks. The fetal stomach appeared to be empty in four cases, and was not described in one case. The fetal skin was described as 'uneven' at ultrasound examination in two cases. Separation of chorionic and amniotic membranes with a peculiar appearance of echo-free fluid in the chorionic cavity and echogenic sediment in the amniotic cavity were observed between 28 + 5 and 32 + 3 weeks in all cases. All fetuses were delivered prematurely between 30 and 34 weeks. All neonates had difficulties in breathing, two developed aspiration pneumonia, and one had bilateral pneumothorax after intubation and died at 6 months because of pulmonary and cardiac sequelae. Prenatal sonographic signs of IPS are separation of the membranes, echogenic amniotic fluid and echo-free chorionic fluid occurring between 28 and 32 weeks' gestation. Delivery occurs at 30-34 weeks and, as there is a high risk of asphyxia, an experienced neonatal intensive care unit team should be present at delivery.

Complete chorioamniotic membrane separation with fetal restrictive dermopathy in two consecutive pregnancies

OBJECTIVE

To describe an instance of complete chorion-amnion membrane separation with fetal restrictive dermopathy in two consecutive pregnancies.

METHODS

We performed prenatal ultrasounds in two consecutive pregnancies and evaluated gross and microscopic postnatal findings.

RESULTS

The first pregnancy ended at 32 weeks of gestation with spontaneous chorioamniotic membrane separation and preterm premature rupture of membranes. The mother delivered an abnormal male infant with generalized fixed joint contractures, rigid and shiny skin, skin laceration around the neck, a rounded and opened mouth, and palpebral conjunctival eversion. The subsequent pregnancy was also complicated by spontaneous complete chorioamniotic membrane separation, oligohydramnios, and fetal growth restriction at 26 + 3 weeks of gestation. A immaturely born second baby also carried multiple anomalies similar to those of the first. Both infants died shortly after birth. After microscopic examination of the skin, we diagnosed the infant as restrictive dermopathy.

CONCLUSIONS

Complete separation of the chorion-amnion membrane may be regarded as a serious prenatal condition. Restrictive dermopathy or skin disorders caused by defects in collagen or elastic tissue metabolism may be one of the many causes of chorion-amnion separation.