Amniotic tyazh – the fibrous soyedinitelnotkanny threads coming from an amniotic cover and tense between uterus walls. Result from small damages of an amnion on early terms of pregnancy, violations of a fruit and placentary blood-groove and pre-natal infections. As a rule, amniotic tyazh proceed favorably and do not pose a threat for development of a fruit. In some cases can squeeze and draw a fruit and an umbilical cord, becoming the reason of malformations. The diagnosis is established on the basis of these tool researches. At threat of a fatal sdavleniye of an umbilical cord or vitals carry out pre-natal removal of a tyazh. In other cases treatment is not required.
Amniotic tyazh (amniotic unions, Simonar's tyazh, syndrome of amniotic banners) – the fibrous threads consisting of connecting fabric. Are the duplikatury amniotic cover tense between uterus walls. According to various data, come to light in 0,12 – 0,015 cases of successfully full-term pregnancy. Presumably are the reason of 178:10000 cases of abortions. Amniotic tyazh are diagnosed not earlier than 12 weeks of a gestation, in 80% of cases do not influence the course of pregnancy in any way and do not cause fruit malformations.
In 70% of cases of a tyazha are not found out when carrying out repeated tool researches that it is caused by their gap or squeezing. In some cases the remaining amniotic tyazh can become the reason of emergence of amniotic banners, cause a hypoxia of a fruit, deformation and congenital amputations of extremities. Diagnostics and treatment amniotic tyazhy are performed by experts in the field of obstetrics and gynecology. Neurologists, orthopedists, surgeons, ophthalmologists and other experts are engaged in treatment of consequences of a pre-natal hypoxia and the malformations caused by this pathology.
Reasons amniotic tyazhy
The reasons of development of amniotic banners are definitely not established so far. There are several theories explaining developing of this pathology. Followers of the first theory consider that amniotic tyazh are formed at microdamages of an amnion on 4-18 weeks of a gestation. The Soyedinitelnotkanny threads which separated from a fetal bubble and freely floating in amniotic liquid can entangle an umbilical cord or various parts of a fruit. In the subsequent the size of a fruit increases, and the size amniotic tyazhy does not change, and it becomes the reason of a sdavleniye of various parts of a body of a fruit.
Supporters of the second theory assume that amniotic tyazhy vascular disorders are the cause. Followers of the third theory point to possible communication between a syndrome of amniotic banners and intrauterine infections. Among the additional contributing factors of development amniotic tyazhy call lack of water, an endometritis, istmiko-tservikalny insufficiency, malformations of genitals of mother, invasive researches during pregnancy and teratogenny effect of some medicines.
There is also genetic theory of emergence amniotic tyazhy, however, most of modern experts do not divide this hypothesis, indicating lack of evidence of inheritance of this pathology. Gynecologists say that the probability of emergence amniotic tyazhy does not correlate the pregnant woman, the number of the previous childbirth, existence of amniotic unions during the previous pregnancies and existence of similar pathology both on maternal, and on the fatherly line with age in any way.
Complications amniotic tyazhy
The most widespread consequence tyazhy Simonara are ring vdavleniye in extremities. Usually disteel departments suffer. Most often at amniotic tyazha II, III and IV fingers of hands are surprised, banners in the area I of a finger of foot meet less often. Damage of one or several extremities is possible. Also multiple banners of one extremity at several levels meet. Amniotic tyazh form the deep furrows sometimes reaching a bone on the surface of an extremity. In the subsequent these furrows interfering normal krovo-and a limfoobrashcheniya, become the reason of development of trophic ulcers, elephantiasis and partial giantism of an extremity.
Because of a sdavleniye of peripheral nerves at amniotic tyazha the paresis and paralyzes which are followed by a muscular atrophy can develop. In hard cases because of gross violations of a blood-groove a disteel part of an extremity nekrotizirutsya and or is torn away in the pre-natal period, or demands amputation after the birth. At rejection in the pre-natal period the become lifeless part of an extremity separates from a fruit and freely floats in amniotic liquid.
Besides, amniotic tyazh in extremities can become the reason of sindaktiliya, kosorukost, false joints, contractures of joints, deformations of nails, violations of a form and the size of extremities. Connection between amniotic tyazha and a congenital clubfoot is established. The syndrome of amniotic banners comes to light at every third child with this pathology. Restriction of mobility of an extremity because of its fixing with a banner and squeezing of a leg with a uterus wall becomes the reason of development of a clubfoot presumably.
In 12% of cases amniotic tyazh cause deformations of the person and a skull. Deformations of a nose, a nezarashcheniye of an upper lip and the sky, squint, increase in distance between eyes, omission of a century, an eyeball underdevelopment, reduction of the sizes of an eyeball, a kolobom of an iris, a cornea metaplaziya, obstruction of plaintive glands or violation of process of a kaltsifikation of a skull are possible. At an arrangement amniotic tyazhy in a trunk can develop (a crevice in a forward wall of a stomach through which internals drop out) and to the omfalotsela (hernia of an umbilical kanatik). Perhaps sdavleny umbilical cords, followed by a fruit hypoxia. It is considered also that in the presence of amniotic tyazhy the probability of premature birth increases.
Diagnostics amniotic tyazhy
Amniotic tyazh expose the diagnosis by results of ultrasonography. Banners can be seen not earlier than the 12th week of pregnancy (sometimes later). In some cases soyedinitelnotkanny threads too thin are also not found in the course of ultrasonic scanning. In similar cases "amniotic tyazh" establish the diagnosis on indirect signs – deformation of an extremity, increase in disteel department of an extremity because of hypostasis etc. Hyper diagnostics is possible.
For specification of the diagnosis, assessment of gravity of threat for a fruit and definition of tactics of treatment of patients with suspicion on amniotic tyazh direct to additional researches: echocardiography of a fruit, MPT and 3D ultrasonography. In most cases amniotic banners do not involve consequences for development of a fruit and do not break the course of pregnancy. In 70-80% of cases of a tyazha independently are broken off, squeezed or resolve and do not come to light when performing repeated ultrasonography.
Treatment amniotic tyazhy and their complications
Treatment usually is not required. Doctors carry out observation, periodically appoint repeated tool researches. At emergence of threat for fruit life (squeezing of an umbilical cord or vitals) carry out surgical interventions on a pre-natal section amniotic tyazhy. Such operations appeared quite recently and so far are rather experimental, than a standard way of treatment amniotic tyazhy, however, cases of their successful end are described.
Tactics of treatment of the child decides on the congenital malformations caused by existence amniotic tyazhy individually. At deep vdavleniye in the extremities interfering normal krovo-and to a lifotok, carry out excision of dense cicatricial fabric within the first year of life. At a sindaktiliya carry out division of fingers, at a clubfoot and a kosorukost carry out conservative and expeditious treatment. At amputations owing to amniotic tyazhy perform prosthetics of extremities.
When splitting the sky and an upper lip several surgical interventions usually are required (from 2 to 7 depending on weight of pathology). Operations carry out step by step, also define age of carrying out a heyloplastika and uranoplastika individually, however all experts consider that treatment and rehabilitation at this pathology need to be finished before achievement of six-year age. Children with the pathology of eyes which developed as a result of amniotic tyazhy are directed to the ophthalmologist, depending on the nature of defect both conservative therapy, and expeditious treatment can be required. At a gastroshizisa and the omfalotsel surgical interventions are shown.