Amniotic bands (other names - Simonar's strands , amniotic fusions ) are fibrous threads that can appear in the amniotic sac (amnion). These threads can pass through the cavity of the amniotic sac, and they can entangle, bind or disrupt the body of the fetus or, leading to malformations. If, as a result of the occurrence of amniotic bands, fetal developmental disorders occur, they speak of amniotic band syndrome.

But the amniotic cord does not always lead to developmental disorders and the occurrence of malformations. Quite often the presence of harmless amniotic cords is detected.

Causes of the appearance of amniotic cords

Until now, the factors leading to the occurrence of amniotic bands have not been identified, so no measures have been taken to prevent their occurrence.

Scientists are considering several versions of the appearance of amniotic bands:

• The first theory calls the cause of the appearance of Simonard's bands a partial rupture of the amniotic bladder at the beginning of pregnancy, but the outer membrane remains intact. The fibrous threads that arise as a result of the breakthrough begin to move in the amniotic fluid and can entangle some protruding parts of the fetus. When the fetus grows and the filaments do not increase, depressions on the fetal body and blood flow disturbances may occur, which lead to dire consequences.
• Another theory considers circulatory disorders and internal vascular disorders as the cause of the appearance of constrictions. This theory arose due to the fact that the previous one cannot explain the occurrence of constrictions and clefts of the palate, lips and non-protruding parts of the body.
• Also considered as causes are intrauterine infections, genital injuries, endometritis, and other diseases.

Diagnosis of amniotic bands

Diagnosing amniotic bands is quite difficult. Sometimes people find out about them only after the baby is born. The earliest period at which it was possible to diagnose constrictions was 12 weeks. If during an ultrasound there is a suspicion that there may be a constriction, additional studies are prescribed: an echocardiogram of the embryo, 3D ultrasound, MRI.

During ultrasound examination, the amniotic septum (cord) appears either as a linear structure that floats freely in the amniotic fluid, or as a dense cord that extends from the placenta and penetrates the fetal body.

A cord not always identified after research can lead to negative consequences. It often happens that amniotic bands are visible on the first image, but not on subsequent ones. The reasons for the loss of these fibrous threads may be their rupture, compression or resorption.

It is necessary to distinguish between amniotic bands and intrauterine synechiae or adhesions, since they may look similar on ultrasound, but in amniotic bands, unlike synechiae, blood flow is not determined.

Possible consequences of the presence of amniotic bands

When entangled in cords, the blood flow in the fetus is disrupted, which can result in consequences varying in severity:

• swelling or stagnation of lymph that causes swelling,
• tissue death (necrosis), which requires amputation of dead tissue after the baby is born,
• congenital amputations,
• ring impressions of fingers and limbs,
• fusion of fingers or toes,
• cleft palate or lip,
• other craniofacial defects, defects of the whole body, spine or umbilical cord,
• constriction of the lower leg can lead to congenital clubfoot.

Another risk in the presence of amniotic bands is possible.

What to do?

If the diagnosis confirms the presence of an amniotic band in the fetus, most often doctors only monitor it throughout the pregnancy. In approximately 80% of cases, these strands disappear. If there is a threat to vital organs or the umbilical cord, an operation is performed to remove the constriction in utero. Such operations are performed extremely rarely, but cases of their successful completion are known.

Superficial constrictions do not require treatment. If the constrictions are deep and swelling has already begun, doctors consider early surgical operations in children possible - in the first year of life. If a child was born with amniotic band syndrome, surgical treatment is prescribed: excision of deep bands to healthy tissue with removal of scars or surgery to transplant fingers from toes to hands to ensure grip.

In case of congenital amputations, they resort to prosthetics of the missing limb or part thereof.

While carrying a child and before conception, you need to think about the fact that all diseases, bad habits and other negative factors will adversely affect the course of pregnancy and the development of the fetus. One of the deviations is an amniotic cord in the uterine cavity during pregnancy. In some cases, such formation leads to abnormal development of the fetus or even its death.

Collapse

What it is?

The amniotic cord refers to special threads that consist of connective tissue and are located between the uterine walls, in the amniotic sac. The outcome of such a pregnancy is different. From its normal course to spontaneous abortion, the appearance of defects or death of the fetus in utero. Pathology can be detected only after the third month of pregnancy, at the beginning of the second trimester.

Causes

It is still impossible to say unequivocally what influences the occurrence of pathology. But, there are factors that can provoke the appearance of a septum in the uterus.

1. Many scientists argue that the amniotic cord occurs as a result of minor damage to the amnion, between the 4th and 19th weeks of pregnancy. The threads that remain after the shell is broken are separated and found inside. At the same time, they can bandage the umbilical cord, arms or legs of the fetus. Throughout the entire period of gestation, the threads are motionless and inextensible, despite this, the fetus grows, which can cause various negative consequences.
2. Other researchers are more inclined to believe that such formations appear due to vascular disorders, which entails the appearance of numerous anomalies.
3. Another version is the influence of intrauterine infection.

In addition to the above factors, we can highlight the presence of:

• oligohydramnios;
• endometritis;
• abnormalities in the development of the genital organs of a pregnant woman;
• isthmic-cervical insufficiency.

Most medications and invasive diagnostics during pregnancy also have a negative effect on the body. This deviation is not inherited. It may appear during the second pregnancy, even if there was no pathology during the first.

Diagnostics

Strands in the amnion can be detected using ultrasound at the beginning of the second trimester, but not always. The threads may be so thin that they cannot be recognized on the screen. If in the future the baby has deformed parts of the body, then this diagnosis is made.

If additional diagnostic measures are required, 3 D ultrasound diagnostics, MRI, and fetal echocardiography are performed. This is necessary to prevent serious consequences for the baby.

In 75% of cases, the septum resolves on its own and does not cause harm. If they were visible at the first ultrasound, but not at the second, then we can talk about a favorable outcome. Of course, if the fetus has no visible defects.

Consequences for pregnancy

If ultrasound diagnostics showed the presence of an amniotic cord in the amniotic sac, then the pregnant woman will need to be regularly monitored by a specialist. Mostly, pregnancy ends positively, but there are exceptions.

If there were no negative consequences at the end of the second trimester, then everything should go well in the future.

Sometimes the septum affects the baby, entangling its various parts of the body (legs, arms, neck, intertwining the umbilical cord, etc.). In some cases, pregnancy is terminated early. Sometimes it needs to be interrupted at the end of the second, beginning of the third trimester due to the fact that the fetus has multiple defects that are incompatible with life or, conversely, to save its life.

Treatment

Pathology is treated only after its long-term presence. The woman constantly goes for examinations for control. If the septum compresses a vital organ for the baby, then radical treatment is prescribed. Modern medicine is improving and it is now possible to cut amniotic cords in utero. In some cases, a caesarean section is performed.

After the birth of a baby who has intrauterine anomalies that appeared due to the above-mentioned partitions, appropriate measures are taken.

1. If the child has severe indentations of the arms or legs and this interferes with normal blood circulation, the scar tissue is excised. The operation must be done within the first 12 months.
2. If there are fused fingers, they are separated.
3. If clubfoot or strabismus is detected, appropriate therapy is prescribed.
4. If a limb was amputated in utero, a special prosthesis can be made.
5. Cleft palate and cleft lip are eliminated through surgical interventions. Keep in mind that one operation will not help, you may need from 2 to 6. The latter must be carried out before the child turns six years old.

Consequences and complications

The amniotic cord contributes to:

• impaired blood flow in the fetus;
• swelling of a certain area;
• the appearance of necrosis (a certain part dies), in the future it will have to be amputated;
• compression of the phalanges of the fingers or the entire limb;
• the occurrence of hemangiomas (benign vascular tumors that rapidly increase in size);
• the appearance of damage to the skull or facial area;
• development of strabismus;
• the appearance of congenital amputations;
• the formation of a “cleft palate” or “cleft lip”;
• premature birth.

If the second ultrasound shows the presence of an amniotic septum, which threatens the health or life of the baby, the doctor decides what to do next.

Prevention

Due to the fact that there is no specific cause of the pathology, there are no clear preventive measures. But, in order to protect yourself and your unborn child, you need to:

• adhere to a healthy lifestyle;
• do not use any medications without a doctor’s permission;
• refuse casual sex;
• eat properly and nutritiously;
• undergo examination before planning pregnancy;
• Regularly visit a gynecologist and do all planned diagnostic measures.

Conclusion

Amniotic cords often resolve on their own and do not require surgery. If necessary, intrauterine dissection is performed or the pregnancy is terminated at any stage. In rare cases, such partitions cause significant harm to the baby, disfiguring his body.

During development, the uterine organ consists of two halves that come together during pregnancy. It turns out that during the intrauterine development of the fetus, the formation of one cavity is considered the norm. However, due to the influence of a number of unfavorable factors, various pathologies in the structure of the uterus may occur during the period of bearing a baby. First of all, the abnormal development of the uterine body includes a septum that forms in the uterine cavity.

The amniotic constriction of the uterine organ is found, as a rule, during pregnancy and is presented in the form of a fold of the membrane that surrounds the fetus. It is important to know that during a multiple pregnancy, the presence of a septum of this type is considered normal. Constrictions can occur as complications after inflammatory diseases of the internal reproductive organs or as a result of surgical intervention in the uterine cavity, resulting in its injury. The development of such a pathology can disrupt the rotation of the fetus, but often does not affect the process of delivery itself. However, if such a diagnosis is made, you should not treat it carelessly, since the health of the unborn baby depends on it.

What are the reasons for the formation of amniotic septa?

Until now, the factors that determine the development of the amniotic cord in the uterus during pregnancy have not been identified, and therefore it is impossible to take certain preventive measures. However, scientists still identify several reasons for the appearance of a cord in the uterine cavity. The sources of development of such pathology can be:

• Infectious processes inside the uterus;
• Injuries of various types of reproductive organs;
• Development of endometritis;
• Oligohydramnios, etc.

You can learn more about the cause of oligohydramnios from this video:

The main versions of the development of amniotic septa

There are two versions that consider the appearance and development of the amniotic cord in the uterus. The first theory includes a (partial) rupture of the amniotic bladder in the early stages of pregnancy (the outer membrane retains its integrity). Scientists speculate that the fibers resulting from the rupture move and entangle certain protruding parts of the fruit. As the fetus grows, these threads do not increase in size, which leads to pressure on its body and disruption of blood flow. And this, in turn, can lead to quite negative consequences.

According to the second theory, the amniotic cord in the uterine cavity is formed as a result of circulatory disorders and internal vascular disorders. This version arose because the first theory does not explain the formation of the cord of the palate, lips and other parts of the body that do not protrude.

What methods of diagnosing amniotic cords exist?

It is quite difficult to diagnose an amniotic cord at the first stage of gestation. It often happens that its presence becomes known after delivery. The earliest period when an amniotic band can be detected is considered to be 12 weeks, since during this period the expectant mother undergoes a mandatory ultrasound examination. If there is a suspicion of the development of a cord in the uterus, the woman is prescribed additional examination: fetal echocardiogram, MRI. A referral for a 3D ultrasound may also be issued.

The photo shows an MRI of a pregnant woman

During ultrasound, the anatomical septum appears as a linear structure that moves freely in the amniotic fluid, or as a dense cord that peels off from the placenta and penetrates into the fetal body. When performing an ultrasound, such a cord may look like adhesions or synechiae inside the uterus, the difference is that blood flow cannot be determined on the septum.

As already mentioned, an amniotic septum does not always cause dire consequences. Often, during the first ultrasound examination, a cord may be visible, but during subsequent studies it is not detected. The explanation for this is quite simple: the septum may disappear due to rupture of the filament fiber or its compression and resorption.

What consequences can the described pathology lead to?

Since the amniotic septum is presented in the form of threads entangling the fetus, which disrupts its blood circulation, the consequences of its development can be very diverse. Among them, it is worth noting the most dangerous:

• Swelling or stagnation of lymph;
• Necrosis (tissue death), which may require amputation of dead areas;
• Indentation of limbs (ring);
• Fusion of fingers and toes;
• Development of hemangiomas (benign formations on blood vessels);
• Defects of varying complexity of the skull, face, body, umbilical cord, spine;
• Development of clubfoot;
• Pathological changes in external organs in the form of “cleft lip”, strabismus and “cleft palate”.

Also, an amniotic septum in the uterine cavity can cause premature delivery.

What measures are taken when amniotic septa form in the uterine organ?

When an amniotic septum forms in the cavity of the uterine body during pregnancy, as a rule, the patient is simply observed throughout the entire period of carrying the child. Studies show that in 80% of women with pathology in the form of a cord, the septum resolves on its own. However, if there is a threat to vital organs or the umbilical cord, the woman undergoes surgery, which consists of intrauterine removal of the cord. It is worth noting that such operations are prescribed quite rarely.

Superficial partitions do not require treatment. And if they are deep and lead to swelling, then there is a possibility of surgery on the newborn child during the first year of life. When a baby is born with amniotic septum syndrome, he is prescribed surgical treatment. The most common type of treatment in this case is excision of the cords and removal of scars, as well as an operation to transplant the fingers onto the hand from the stem in order to ensure grip. In rare cases, the development of an amniotic septum leads to termination of pregnancy.

Since the causes of amniotic pathology have probably not yet been identified, and inflammation of various organs can lead to serious consequences, every woman should take special care of her health while carrying a baby. It is also necessary to undergo all tests recommended by doctors on time.

Amniotic cords- fibrous connective tissue threads originating from the amniotic membrane and stretched between the walls of the uterus. They arise as a result of minor damage to the amnion in early pregnancy, disturbances in fetal-placental blood flow and intrauterine infections. As a rule, amniotic cords develop favorably and do not pose a threat to the development of the fetus. In some cases, the fetus and umbilical cord may be compressed and pulled, causing developmental defects. The diagnosis is established on the basis of instrumental studies. If there is a threat of fatal compression of the umbilical cord or vital organs, intrauterine removal of the cord is performed. In other cases, no treatment is required.

General information

Amniotic cords (amniotic fusions, Simonard's cords, amniotic band syndrome) are fibrous strands consisting of connective tissue. They are a duplication of the amniotic membrane stretched between the walls of the uterus. According to various data, they are detected in 0.12 - 0.015 cases of successfully full-term pregnancy. Suspected to be the cause of 178:10,000 miscarriages. Amniotic cords are diagnosed no earlier than 12 weeks of gestation; in 80% of cases they do not affect the course of pregnancy and do not cause fetal malformations.

In 70% of cases, the cords are not detected during repeated instrumental examinations, which is due to their rupture or compression. In some cases, persistent amniotic cords can cause the appearance of amniotic bands, cause fetal hypoxia, deformities and congenital amputations of limbs. Diagnosis and treatment of amniotic cords is carried out by specialists in the field of obstetrics and gynecology. The consequences of intrauterine hypoxia and developmental defects caused by this pathology are treated by neurologists, orthopedists, surgeons, ophthalmologists and other specialists.

Causes of amniotic bands

The reasons for the development of amniotic bands have not yet been precisely established. There are several theories explaining the occurrence of this pathology. Followers of the first theory believe that amniotic cords are formed due to microdamage to the amnion at 4-18 weeks of gestation. Connective tissue threads separated from the amniotic sac and freely floating in the amniotic fluid can entangle the umbilical cord or various parts of the fetus. Subsequently, the size of the fetus increases, but the size of the amniotic cords does not change, and this causes compression of various parts of the fetal body.

Proponents of the second theory suggest that the cause of amniotic cords is vascular disorders. Followers of the third theory point to a possible connection between amniotic band syndrome and intrauterine infections. Additional predisposing factors for the development of amniotic bands include oligohydramnios, endometritis, isthmic-cervical insufficiency, malformations of the maternal genital organs, invasive studies during pregnancy and the teratogenic effect of certain medications.

There is also a genetic theory of the occurrence of amniotic cords, however, most modern experts do not share this hypothesis, pointing to the lack of evidence of inheritance of this pathology. Gynecologists say that the likelihood of amniotic cords does not correlate in any way with the age of the pregnant woman, the number of previous births, the presence of amniotic fusions during previous pregnancies and the existence of a similar pathology on both the maternal and paternal lines.

Complications of amniotic bands

The most common consequence of Simonard's bands is ring impressions in the extremities. Usually the distal parts are affected. Most often, with amniotic cords, the second, third and fourth fingers are affected; less often, constrictions in the area of ​​the first toe are found. One or more limbs may be affected. There are also multiple constrictions of one limb at several levels. Amniotic cords form deep grooves on the surface of the limb, sometimes reaching the bone. Subsequently, these furrows, which interfere with normal blood and lymph circulation, become the cause of the development of trophic ulcers, elephantiasis and partial gigantism of the limb.

Due to compression of peripheral nerves with amniotic cords, paresis and paralysis may develop, accompanied by muscle atrophy. In severe cases, due to severe disturbances in blood flow, the distal part of the limb becomes necrotic and is either rejected in the prenatal period or requires amputation after birth. During intrauterine rejection, the dead part of the limb is separated from the fetus and floats freely in the amniotic fluid.

In addition, amniotic cords in the extremity area can cause syndactyly, clubhandedness, false joints, joint contractures, nail deformities, and disturbances in the shape and size of the extremities. A connection has been established between amniotic cords and congenital clubfoot. Amniotic band syndrome is detected in every third child with this pathology. The reason for the development of clubfoot is presumably the restriction of the mobility of the limb due to its fixation by a constriction and compression of the leg by the wall of the uterus.

In 12% of cases, amniotic cords cause deformities of the face and skull. Possible deformities of the nose, cleft lip and palate, strabismus, increased distance between the eyes, drooping eyelid, underdevelopment of the eyeball, reduction in the size of the eyeball, iris coloboma, corneal metaplasia, obstruction of the lacrimal glands, or disruption of the calcification process of the skull. When the amniotic cords are located in the torso area, gastroschisis (a cleft in the anterior wall of the abdomen through which internal organs prolapse) and omphalocele (hernia of the umbilical cord) can develop. Possible compression of the umbilical cord, accompanied by fetal hypoxia. The presence of amniotic bands is also thought to increase the likelihood of preterm birth.

Diagnosis of amniotic cords

The diagnosis of amniotic cords is made based on ultrasound results. Constrictions can be seen no earlier than the 12th week of pregnancy (sometimes later). In some cases, the connective tissue threads are too thin and are not detected during ultrasound scanning. In such cases, the diagnosis of “amniotic bands” is established based on indirect signs - limb deformation, enlargement of the distal limb due to edema, etc. Overdiagnosis is possible.

To clarify the diagnosis, assess the severity of the threat to the fetus and determine treatment tactics, patients with suspected amniotic cords are referred for additional studies: fetal echocardiography, MRI and 3D ultrasound. In most cases, amniotic bands do not entail consequences for the development of the fetus and do not disrupt the course of pregnancy. In 70-80% of cases, the cords spontaneously rupture, are compressed or dissolve and are not detected during a repeat ultrasound.

Treatment of amniotic cords and their complications

Treatment is usually not required. Doctors monitor and periodically prescribe repeated instrumental studies. If there is a threat to the life of the fetus (compression of the umbilical cord or vital organs), surgical interventions are performed to intrauterine dissection of the amniotic cords. Such operations have appeared quite recently and are still more experimental than a standard method of treating amniotic cords, however, cases of their successful completion have been described.

Treatment tactics for a child with congenital malformations caused by the presence of amniotic cords are determined individually. In case of deep depressions in the area of ​​the extremities that interfere with normal blood and lymph flow, dense scar tissue is excised during the first year of life. For syndactyly, finger separation is performed; for clubfoot and clubfoot, conservative and surgical treatment is performed. For amputations due to amniotic cords, limb prosthetics are performed.

Cleft palate and upper lip usually require several surgical interventions (from 2 to 7 depending on the severity of the pathology). The operations are performed in stages, the age of cheiloplasty and uranoplasty is also determined individually, however, all experts believe that treatment and rehabilitation for this pathology must be completed before reaching the age of six. Children with eye pathology that has developed as a result of amniotic cords are referred to an ophthalmologist; depending on the nature of the defect, both conservative therapy and surgical treatment may be required. For gastroschisis and omphalocele, surgical interventions are indicated.

With this pathology, constrictions (amniotic fusions, Simonard's cords) appear inside the fetal bladder - fibrous formations floating in the amniotic fluid. At a very early stage, they do not create problems, but as the child grows in utero, they can wrap around his body, leading to serious consequences.

Causes of formation of amniotic cords

The exact cause of the formation of adhesions has not yet been established, but there are several theories that explain this phenomenon:

• Damage to the fertilized egg at the beginning of pregnancy, leading to disruption of the development of the amnion (the inner lining of the fetal bladder).
• The entry of microbes into the uterine cavity, causing inflammation of the membranes of the bladder (amniotitis) or the uterus (endometritis). This theory is supported by the more frequent development of pathology in women suffering from chronic inflammatory processes of the genital area and STDs.
• Vascular disorders that prevent adequate blood supply to the fetal egg and lead to improper development of its inner membrane.
• Viral infections suffered at the very beginning of pregnancy that affect the development of the amniotic sac. TORCH infections (toxoplasmosis, cytomegalovirus, rubella, herpes) are especially dangerous, but ordinary flu or acute respiratory infections can create problems.
• Anomalies in the development of the uterus, making it difficult to form a full-fledged amniotic sac (childish, bicornuate saddle-shaped organ).
• Isthmic-cervical insufficiency is a weakness of the uterine cervix, which is unable to support the enlarging amniotic sac. Dilatation of the cervical canal leads to rupture of the amniotic membrane and penetration of infection into the uterus.

How does pathology develop?

While the embryo is small, the constrictions float inside the bladder. Then, in some cases they resolve, but sometimes Simonara strands interfere with pregnancy.

Wrapped around the arm, leg, neck or head of the fetus, the constrictions compress the tissue, impeding blood circulation. This leads to scar formation and disruption of intrauterine development. Children are born with underdeveloped or missing finger phalanges, hands and feet. Compression of nerves and blood vessels causes paralysis of the limbs, atrophy of muscles and tendons.

Impaired blood supply to the joints, caused by compression of the limbs by cords, leads to the birth of children with inflexible, inextensible, unnaturally inverted limbs, clubfoot and clubbed hands.

With significant tissue compression, tissue death occurs. During this time, a severed limb is discovered floating in the amniotic fluid separately from the fetus. Sometimes an arm or leg completely loses functionality and “dries out,” so it has to be removed after the baby is born.

When the umbilical cord is compressed, the supply of oxygen and nutrients stops and the fetus dies. With incomplete compression, the child develops under conditions of hypoxia, leading to underdevelopment of the brain and cerebral palsy.

In 12% of cases, compression of the child’s face occurs. Violation of tissue nutrition of the maxillofacial area leads to serious pathologies - deformations of the nasal area, facial asymmetry, underdevelopment of the eyeballs, lacrimal glands and ears on the affected side. Facial clefts, cleft palate (cleft palate) and cleft lip (cleft lip) occur. Compression of the facial nerves causes congenital strabismus, problems with vision and hearing.

Compression of the fetal abdominal area by a cord leads to gastroschisis - a cleft on the anterior abdominal wall and omphalocele - a hernia of the umbilical cord. With these pathologies, the baby’s intestines and internal organs extend beyond the abdominal cavity. Children often die in utero, and those who survive require major surgery.

At what time are amniotic cords detected?

In most cases, the pathology is visible during. But sometimes constrictions are discovered later. The situation is best seen with 3D and 4D ultrasound. During the examination, it is determined whether the cords have touched parts of the child’s body and whether they are interfering with the free movement of the fetus.

If amniotic bands are detected, the woman is prescribed fetal echocardiography, which reveals hypoxia. If during the examination it is clear that the cords are not rough, small and located outside the baby’s body, the woman is prescribed constant monitoring. In approximately 70% of cases, pregnancy can be carried to term by constantly monitoring the condition of the fetus via ultrasound.

As a rule, if the cords have not caused complications up to 25 weeks, they will not interfere with pregnancy in the future. If entanglement occurs at a late stage and still occurs, emergency delivery is performed. The choice of labor management depends on the location of the constriction and its thickness. Often you have to resort to a caesarean section.

If constrictions crossing the baby's body are detected at an early stage, termination of pregnancy is proposed due to the high risk of deformities in the child. Women who risk leaving such a pregnancy need to understand that the risk of premature birth and intrauterine death will be high, and subsequently the baby will need long-term rehabilitation and prosthetics.

Some clinics offer surgery for endoscopic dissection of the amnion constriction. Unfortunately, this method has not yet been sufficiently developed, so it often does not produce results, ending in fetal death or premature birth.

Prevention

The simplest and easiest way to avoid the problem is thorough preparation for pregnancy, which reduces the risk of the formation of Simonard's bands and other complications. Before the planned conception, you need to treat existing inflammatory processes in the genital area, get checked for and.

In case of isthmic-cervical insufficiency, interventions are carried out to prevent premature opening of the cervix and prevent microbes from entering the uterine cavity.

Since the only method for detecting pathology is ultrasound examination, it must be completed several times throughout pregnancy. If the presence of amniotic cords is suspected, additional and out-of-time screening will be required.