LIMB AMPUTATION IN AMNIOTIC BAND SYNDROME - SERIAL ULTRASONOGRAPHIC AND DOPPLER OBSERVATIONS

A 28-year-old woman, gravida 7, para 6, was referred at 21 weeks' gest ation to our ultrasound unit because of bilateral fetal lower limb ede ma diagnosed previously. Ultrasonography showed a constriction ring ar ound both legs, and, with the aid of color Doppler, arterial flow was demonstrated in both legs beneath the constriction ring. Subsequent ex aminations during the 24th and 28th weeks revealed absence of pow belo w the constriction ring of the right leg and decreased pow in the left leg. This was followed by the gradual bending, breaking and resorptio n of the tibia and fibula of the right leg. Between weeks 30 and 34, g radual shrinkage of the remains of the right leg beneath the knee was recorded by serial ultrasonic observations. At the 38th week of gestat ion, a male infant was born by normal vaginal delivery. Examination at birth revealed amputation of the right leg below the knee, with a den uded end of the stump. There was a partial amputation of the left leg below the Knee, with tissue continuity being maintained by the posteri or neurovascular bundle, and a posterior strip of skin. The left foot was extremely edematous, with an area of necrosis dorsally. This case afforded us the opportunity of in utero following of natural limb ampu tation in the amniotic band syndrome.