Sometimes clinically healthy mothers give birth to children with morphological defects: the absence of phalanges of the fingers, limbs and even the head. Mothers despair, reproach themselves or doctors for what happened to their child. Sometimes it comes to trial. But what is really the cause of these birth defects?
Definition
Amniotic constrictions, otherwise called "amniotic fusion" or "Simonar cords", are a duplicate of the amnion tissue, which is stretched between the walls of the uterus. As a rule, it does not harm the embryo and does not present complications in childbirth. But in rare cases, serious consequences are possible.
Amniotic constrictions are fibrous filaments that occur in the fetal bladder. They can squeeze or bandage the umbilical cord, attach to parts of the fetal body, causing malformations (amputation of the arms, legs, fingers or their phalanges, sometimes decapitation).
Causes
There are two theories why amniotic constrictions appear. The reasons for this phenomenon are explained by frequent ruptures of the amniotic bladder in early pregnancy. Since the chorion remains intact, no threat of interruption in the development of the embryo is observed, but the threads that arise due to ruptures float freely in the amniotic fluid. They can cling to parts of the fetal body. Over the course of pregnancy, the baby grows, but the threads remain the same as they were, so tissue compression, ischemia and necrosis occur.
Some time later, the second theory appeared, since the first did not suit skeptics who noticed that amniotic constrictions (fibrous filaments in the stomach of a pregnant woman) appear simultaneously with other congenital malformations, such as cleft lip or cleft palate. These doctors suggested that the cords are due to vascular or circulatory disorders of the fetus.
Another option for the development of events is intrauterine infection, as well as injuries during pregnancy, genital abnormalities (doubling of the uterus, two-horned uterus , etc.), ICN (isthmic-cervical insufficiency), amnion inflammation, endometritis, and oligohydramnios. But none of these theories has been conclusively confirmed.
Diagnostics
In most cases, clinically and laboratory fail to detect amniotic constriction. The photo from the ultrasound study is not informative, since these threads are very thin. Indirectly, it is possible to determine enlarged and swollen limbs in places of compression. Overdiagnosis of this pathology is largely common. Therefore, if the doctor suspects the presence of amniotic cords, the pregnant woman is referred for MRI or 3D ultrasound.
More than half of the diagnosed amniotic constrictions on repeated ultrasounds are not detected due to their rupture.
Statistics
Depending on the technical equipment of the antenatal clinic, the frequency with which amniotic constrictions are detected can range from 1: 1200 to 1:15 000 births. It is believed that two hundred out of ten thousand miscarriages occur precisely for this reason. In eighty percent of cases, Simonar cords deform fingers and hands, and another ten percent is cord compression. It is the formation of nodes on the umbilical cord that leads to hypoxia and antenatal death of the fetus.
Fortunately, most diagnoses of the syndrome of amniotic constriction are not clinically confirmed, or fibrous filaments do not cause significant damage to the fetus.
Heredity
The likelihood that amniotic constrictions appear during pregnancy is extremely small. This is not a hereditary disease. As a rule, genomic or chromosomal mutations appear symmetrically, and in this case, the threads attach absolutely randomly. If during the first pregnancy the child had Simonar's cords, then this does not mean that subsequent children will be injured. Also, this does not mean that a child with developmental defects will be born from parents who have had an amniotic constriction syndrome in utero.
Effects
Although amniotic constrictions are not a deadly pathology, their consequences are very depressing. Due to the fact that the cords can entangle parts of the fetal body, lymph stagnation develops. This leads to swelling and necrosis. After birth, such limbs must be amputated, otherwise CRUSH syndrome will develop: toxins that accumulate in the anesthetized part of the limb will enter the systemic circulation and begin to poison the baby’s organs. This could lead to his death. Therefore, it is necessary to remove a limb if it is already not viable. And as quickly as possible.
In addition, with amniotic constriction syndrome, extremities and fingers can be pressed into the proximal part of the limb. Finger joints or phalanges of the fingers and toes are common among these children. Sometimes, in addition to constrictions, the child has other stigmas of dysembryogenesis: cleft palate and upper lip. In very rare cases, gross violations of the development of the spine and facial skull, eventual abdominal organs, and atresia of the umbilical cord occur.
If the constriction affects blood vessels located close to the skin, then a hemangioma forms at this point. The tumor after birth will need to be removed.
Some scholars find a connection between Simonar’s cords and clubfoot. This is due to the fact that the legs of the fetus are fixed with fibrous threads, so the walls of the uterus can squeeze the feet of the fetus. In twenty percent of cases, this pathology is bilateral. Another risk that an obstetrician-gynecologist should consider is premature birth. This complication is a common occurrence in pregnancies that occur with amniotic constriction syndrome.
Treatment
As a rule, in utero this disease is not treated. In medical practice, there are casuistic cases when transvaginal or laparoscopic operations were performed. But this was an extreme measure, as vital organs were squeezed. But these are extremely rare amniotic constrictions. Treatment is usually carried out after the birth of the baby.
The fibers are dissected and, if necessary, amputated part of the limb. To improve the quality of life, you can transplant fingers upside down.
Forecast
The prognosis for life and health is generally favorable. Children in most cases grow and develop according to age. Every year, prosthetic limbs are improved, so with the loss of the forearm, hand, lower leg or foot, it is possible to put an artificial replacement. Children are advised to change their dentures as they grow older. If the constrictions caused a minor functional defect, then the cosmetic defect can be eliminated by transplanting fingers, as well as their phalanges.
In people with amniotic constriction syndrome, completely healthy children can be born, since this disease is not inherited.
Celebrities Who Had Simonar Tie
The time has already passed when people with amputation of limbs hid in their homes and were ostracized by society. Now they can live with virtually no limits, hold important public posts, play sports, speak on television and participate in beauty contests.
Some famous people are not shy about being born with congenital amputations, but whether this happened due to amniotic constrictions is an open question.
- Carrie Burnell is an actress who was born without a right forearm. She works on a children's channel. This caused a mixed reaction among young viewers and their parents and served as an impetus for the emergence of a series of programs on how to tell children about disabilities and the characteristics of their lives.
- Jim Abbot is familiar to all baseball fans. He is a legendary pitcher, that is, a server without a right hand. He left big sport at the end of the twentieth century, but his example continues to inspire many people with disabilities and Paralympics.
- Teresa Yucatil - the beauty of Miss America, was born without a left hand. I didn’t put on a prosthesis during the competitions to show that you can be beautiful without artificial details.
- Kelly Knox is a top model with no left forearm. In 2008, she won the reality show on Air Force 3. In addition to her, seven more girls with various injuries participated in this contest.
- Nicholas McCarthy is a famous pianist who was born without a right hand.
- Nicholas Vuychich is an Australian Christian preacher. Known for being born without all limbs. He publishes his books and travels with seminars around the world as an example of not giving up even in the most difficult situations.
- Mark Goffeny is a guitarist born with amputated arms. He learned to play with his toes.