Eco, Gravidanza

Sindrome da banda amniotica (Amniotic Band Syndrome, ABS)

La sindrome della banda amniotica (Amniotic Band Syndrome, ABS) detta anche “ADAM complex” (amniotic deformity, adhesions, and mutilations) si verifica quando il feto si ritrova bloccato in una briglia della membrana amniotica con limitazioni dei movimenti, compressione vascolare  e necrosi tissutale (1,2).

La sindrome della banda amniotica può causare una serie di difetti fetali diversi a seconda delle parti fetale impedite nella loro funzione. Se una briglia  avvolge strettamente un arto, l’arto stesso può essere in parte o completamente amputato, Il bambino può nascere con le dita delle mani o dei piedi mutilate o malformate (3-7).

Il piede torto riconosce l’ABS come una dei fattori etiologici più frequenti.

Se la briglia si stringe attorno al viso,  possono formarsi alterazioni del labbro, naso, orbite, etc,

L’ABS può anche essere causa di aborto o morte fetale  se la briglia intrappola il cordone ombelicale bloccandone il flusso  vascolare (8-10).

La diagnosi –  in genere è effettuata casualmente durante un controllo ecografico di routine. La banda amniotica si presenta come una formazione filiforme, generalmente non vascolarizzata (45-47).  L’ultrasonografia tridimensionale in modalità di rendering consente un’analisi spaziale del feto e della banda amniotica, consentendo così una migliore comprensione dei rapporti fra la banda e le parti fetali (48,49).

L’ABS interessa lo 0.8% delle gravidanze. L’etiologia non è ancora nota  ma secondo la teoria più accreditata le briglie amniotiche sono causate da microfratture dell’amnios a seguito di traumiamniocentesi, villocentesi. Altre cause sembrano essere rappresentate da iperglicemia, fumo e uso di droghe. Una teoria genetica chiama in causa anomalie di sviluppo del disco germinale. (10-18)

Nel 70% dei casi le briglie scompaiono da sole e senza conseguenze nel corso del II-III° trimestre di gravidanza (45). Spesso infatti con il procedere della gravidanza l’aumento di volume dell’utero ne causa la rottura o l’appiattimento contro le pareti uterine stesse (19-30).

TERAPIA: Se la banda amniotica non provoca lesioni e non interrompe il flusso sanguigno, non è necessario alcun intervento chirurgico. Se invece la banda amniotica impedisce il flusso ematico di un arto o del cordone ombelicale o minaccia di provocare una deformazione facciale, la chirurgia in utero (rimozione della banda amniotica mediante fetoscopio operatorio) può essere una valida opzione, nei casi gravi, per impedire mutilazioni, deformazioni fetali e morte fetale dopo aver valutato il rapporto costo/benefici che possa giustificare tale tipo di intervento (31-38). Le complicazioni più frequenti sono il parto pre-termine  e la rottura prematura delle acque (PROM) (39,40).

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