Amniotic Band Syndrome

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What is amniotic band syndrome?

In amniotic band syndrome, thin strands of tissue form inside the sac of fluid that surrounds and protects babies in the womb (amniotic sac). The strands tangle around the baby, like strings or rubber bands, trapping parts of their body. Pressure from the strands can affect the way your baby forms. 

As your baby grows, the strands make creases, or indentations, in their tissue. These creases are called amniotic bands. Most bands affect only the outer layers of , like the baby’s skin and the tissue just under their skin (subcutaneous tissue). Tighter bands may go as deep as the bone. 

Amniotic band syndrome is rare, and doctors do not know what causes it.  

This condition is known by many other names, including: 

  • Amniotic constriction bands 
  • Constriction band syndrome 
  • Congenital constriction rings 
  • Streeter anomaly 
  • Streeter bands 
  • Streeter dysplasia 
  • What body parts can be affected?

    Bands happen most often around a baby’s arms or legs. Often, the bands go all the way around the limb. Some go only partway around (incomplete bands). Bands can also form around the head, face, or belly (abdomen). The exact effects depend on where the bands are and how early they began.

  • Is amniotic band syndrome serious?

    In the mildest cases, amniotic band syndrome causes a single, shallow crease on 1 limb. The crease can be seen, but it doesn’t cause problems with the way the limb works. Some children have multiple deeper bands.

    In more serious cases, bands that compress blood vessels may reduce blood flow to parts of your baby’s body. This may limit growth or injure tissue as the baby develops. Bands can be so tight that the tissue past them cannot survive because it doesn’t get enough blood. These bands may cut off fingers, toes or other parts of the arms or legs before a baby is born ( amputation or intrauterine amputation). If bands injure but do not amputate your baby’s fingers or toes, the  may heal together in the womb and cause a type of syndactyly (acrosyndactyly). Sometimes the digits are fused only at the tips. 

  • Other complications from amniotic band syndrome

    If bands compress nerves, they may cause other problems. A band around a nerve that controls the lower leg and foot (peroneal nerve) is 1 cause of clubfoot.

    If bands cross your baby’s head, face, chest or belly (abdomen), they may cause more serious problems with your baby’s development. This is very rare.

 

Orthopedics and Sports Medicine at Seattle Children's

Seattle Children’s pediatric orthopedics team partners with researchers around the world to make sure we are using the latest treatment approaches and technologies.

 

What are the symptoms of amniotic band syndrome?

The effects of amniotic band syndrome can vary widely. They depend on where the bands are and how early the bands formed during your baby’s development.

Your baby may have 1 or more of these:

  • Creases, or indentations, around their finger, hand, arm, toe, foot or leg
  • All or part of a limb missing
  • Swelling (edema) because bands restrict the flow of blood or 
  • A difference in the length of their arms or legs
  • Very rarely, a gap (cleft) or other difference in their head, face, belly (abdomen) or chest

How is amniotic band syndrome diagnosed?

Doctors can diagnose amniotic band syndrome by doing a physical exam when your baby is born. Your baby may need an  to see how a band affects deeper tissues under their skin. If a band is deep, your baby may have an  scan or other imaging scan to see how the band affects their blood vessels and nerves.

Diagnosis before birth 

Sometimes, but not usually, doctors can diagnose amniotic band syndrome based on what they see during an before a baby is born. If this happens, talk with your healthcare team about what they can tell from the ultrasound and what it may mean for you and your baby. Our team at Seattle Children’s is happy to provide prenatal consultations to talk with you about your baby’s condition. 

How is amniotic band syndrome treated?

Treatment for amniotic band syndrome will be custom-made for your baby and how the bands affect them.  

If the bands are shallow and don’t cause any symptoms or health problems, your baby may not need any treatment. Even so, surgery may be an option to give the affected body part a more typical look.

Some babies need surgery to correct or prevent problems caused by the bands. The main concerns are that bands can reduce blood and lymph flow or press on nerves.

Surgery to Release Bands

If an amniotic band constricts a baby’s tissues, doctors perform surgery to release the band. The surgery requires careful work around the baby’s blood vessels and nerves. The exact method the surgeon uses will depend on details of your baby’s bands, like the number of bands, where they are and how deep and close they are.

What to expect during surgery

Typically, the surgeon makes cuts (incisions) in the skin along the band. The surgeon removes extra or fragile skin that went down into the crease in your baby’s soft tissue.

Next, the surgeon makes zigzag cuts in your baby’s skin above and below the band. This is called Z-plasty. It creates pointed flaps of skin. Then the surgeon gives a more normal contour to your baby’s soft tissue under the skin. 

Finally, the surgeon brings the pointed flaps of skin together from above and below the band and closes the incisions. The zigzag method helps prevent scars that could restrict the tissue later. The doctor will want your child to come back for follow-up visits to make sure they are healing well. 

Surgery timing 

The timing of surgery depends on the effects of the bands. Usually, surgery happens after a baby is at least 6 months old and often when they are at least 1 year old. Very rarely, babies need surgery in the days right after birth.

Your baby may need urgent surgery right after birth if:

  • Bands press deeply on blood vessels or nerves
  • Bands cause serious swelling () or other problems

Most of the time, surgery for amniotic bands is done as . Based on how your baby is affected, they may need more than 1 surgery.

Fetoscopic release of amniotic bands

Fetoscopic release is a minimally invasive procedure to release amniotic bands during pregnancy. This can be done after 16 weeks if the bands are severe. The fetal intervention provider inserts a fetoscope (a tiny tube with a camera on the end) into the womb to see the bands and then loosen them with small scissors or laser energy.

Seattle Children’s Maternal Fetal Intervention and Surgery Program provides this highly specialized procedure. If your baby is diagnosed before birth, our team can talk with you about your baby’s condition, the treatment options, the risks and benefits of releasing bands before birth or waiting and what to expect.

Other Treatments

Other treatments will depend on your baby’s needs. They may include:

  • Surgery to move affected bones into a better position (realignment surgery)
  • Clothes that apply pressure to control swelling (compression garments)
  • Tools that help your child do things on their own (adaptive equipment)
  • Prosthetics to replace missing body parts

If your baby has another condition linked to amniotic band syndrome, like syndactyly or clubfoot, they may need surgery or other treatment for this condition too.

Why choose Seattle Children’s for amniotic band syndrome treatment?

At Seattle Children’s we bring together a team of experts to evaluate your baby and create a treatment plan to get the best results for them. Based on your baby’s needs, their team may include members from Orthopedics, Occupational Therapy, Orthotics and Prosthetics, Plastic Surgery, Neurosurgery, Craniofacial and other areas. 

If your developing baby is diagnosed with amniotic bands during your pregnancy, Seattle Children’s Maternal Fetal Intervention and Surgery Program can see you to discuss if release of the bands may be helpful. 

  • The experts you need are here
    • Your baby’s team includes , pediatric , , , nurses, certified , registered and others based on their condition and treatment plan.
    • For many of our patients, treatment means surgery. Our surgeons are experienced at doing surgeries to release bands and correct the effects of bands on the way your baby formed.
    • Amniotic bands sometimes affect more than 1 part of a child’s body, like their nerves along with their skin. That’s why we connect you with any type of Seattle Children’s expert your child needs.
  • Care from before birth through young adulthood
    • We specialize in caring for kids. This means our experts have the knowledge, training and skills to treat the youngest patients, including babies and young children with amniotic band syndrome. At Seattle Children’s, your child’s team has special training in physical, emotional and social needs of young people. 
    • If your baby is diagnosed with amniotic band syndrome before birth based on an , we offer prenatal consultations to talk with you about your baby’s condition. Most babies who need treatment will receive care after birth. Fetoscopic release of bands may be an option in some cases. Experts from our Maternal Fetal Intervention and Surgery Program offer this treatment, if needed, and can talk with you about your family’s needs and options.  
    • Babies and children are still developing. When we evaluate your child’s condition, plan their treatment and provide their care, we carefully consider their growth. We think about how growth may affect your child’s body over time. We also consider how their condition and treatment may affect the rest of their development and health. 
    • We have the largest group of  pediatric radiologists in the Northwest. If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images. 
  • Support for you and your family
    • We know it can be stressful to have a child with amniotic band syndrome and to find the treatment they need. Everyone at Seattle Children’s works to make your experience here as easy as we can on your whole family.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options.
    • Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.
  • Research to improve care
    • Seattle Children’s takes part in the CoULD Registry for congenital upper limb differences. A registry is a place where researchers keep information about people who have a certain condition so they can learn more about it. CoULD connects researchers from children’s hospitals around the country to study treatments and improve life for kids born with arms and hands that aren’t typical.  
    • Learn more about current orthopedics research at Seattle Children’s. 

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