Amnion And The Chorion

11 Replies
Alison - September 1

Hi everyone! I had an U/S this week at 16 weeks and the tech said it was unusual for the amnion (sac surrounding the baby) not to have fused with the chorion (the outer protective sh__l?) She asked had I had any bleeding or anything and I told her I have not. She said it was probably nothing to worry about and that it was probably about to fuse and she would note it for my doc. who I see this next week. Anyone else had any similar circ_mstances?

 

CK - September 9

I have the same condition, diagnosed at 17 weeks. My perinatologist says it has been linked with chromosomal abnormalities, fetal death, preterm labor, or nothing at all - in some cases the pregnancy is fine. We're having another Level II U/S in two weeks and may have an amnio if the U/S looks bad. There are not many studies (maybe 3 or so) about this condition, so the information out there is scarce.

 

Alison - September 12

CK, thanks for the response. So, did your general OB refer you to a perinatologist for this reason? I hope you don't mind me asking you these questions. I apologize if I seem intrusive. I saw my OB Thursday who didn't seem concerned about the situation at all. Basically he said there is nothing to do about it and didn't have any explanation as to what causes it. I go for another U/S on the 29th. Did your first U/S show anything unusual other than the amnion/chorion condition and has your perinatologist recommended any precautions for you to take? When are you due? My due date is Feb. 20th. Thank you so much for your response. Do you have any suggested websites regarding these studies?

 

CK - September 12

Hi Alison, No, I have been seeing a peri in addition to my regular OB because we terminated our last pg because our baby had a servere congenital heart defect and she had very little hope of survival without major, major surgeries and much suffering. Because of the diagnosis, I guess I am now considered "high risk," (also, 35 is fast approaching!!) so we have seen the peri for 3 Level II u/s for this pregnancy to rule out the same heart defect. While there does not apprear to be the same heart defect (and no other apparent defects), they saw a rather large separation of the amnion-chorion in one area. My peri looked at two studies, both done in 1999. You may want to have your doctors look them up: "Amnion-chorion separation after 17 weeks' gestation" by Bromley (out of the Harvard Medical School) and "Unfused amnion chorion after 14 weeks of gestation: a__sociated fetal structural and chromosomal abnormalities" by Ulm out of University Hospital of Vienna, Austria. I found one other study via google and gave it to my OB last week to give to my peri (they all know I am a control freak and need to do my own research!!!). It was from 1985: "Separated chorioamnion and elevated chorion: sonographic features and clinical significance" by Kaufman, Fleischer, et al. This last study was not as dire as the other two, and my peri was the first to admit that the studies were not complete for various reasons, such as that the women in the Bromley study had not been scanned adequately to diagnosis the separation before they had undergone amnios (apparently an amnio can cause the separation, so it wasn't clear in the Bromley study whether the amnio caused the separation for most of the women or whether the separation really was linked to the chromosomal problems). Nevertheless, there does appear to be some link. By the way, you can get the abstracts from these studies on the internet. My doctor gave them to me, but I found them during my own research via google. Just type in the first few words from the t_tles and you can pull them up. My OB said he has seen this condition maybe 20-25 times in his practice, and that none of them have ever been linked to chromosomal problems. But I have a wonderful OB and peri who want to make sure they have as much information as possible so we know all of the facts. Personally, I would ask your OB to be referred to a perinatologist for a Level II u/s where they can check more accurately for things like fetal growth, etc., to try to rule out chromosomal issues. So far we've had a nuchal transluscency scan (before the a-c separation diagnosis) which came back really good (the NT Scan can help to rule out chromosomal abnormalities and heart defects) and my AFP came back really good. We would have had an amnio at the u/s where he diagnosed the separation, but my peri said I have an increased risk of miscarriage because of the a-c separation, so we didn't want to risk it w/o other information. Incidentally, I am due Jan. 29, and we have one perfectly healthy toddler at home. We are trying to be hopeful, but we have seen the worst of what can go wrong with our last pregnancy, so we know how bad it can get. I don't mean to scare you, and I think the general consensus among OB's is that everything will turn out fine, but it's the peris who know the most information and can do the most detailed scans. I hope this has helped! Good luck!

 

Alison - September 21

Hey CK, hope you are still around on the forum. I wanted to check-in with you to see if you have had your other Level II U/S yet. Please let me know how you are doing.

 

CK - September 23

Hi Alison, I just had my Level II u/s yesterday and it went very well. The heart looked great and the amnion-chorion separation had fused. Furthermore, my peri did not see any other "soft markers" for chromosomal abnormalities. He didn't even recommend doing an amnio. Phew! That being said, he told me that I am still have the other risk factors because I statistically had a separation after week 16. So he wants me to read up on signs of pre-term labor (from the March of Dimes website) and have more frequent visits with my OB to make sure I am not showing signs of fetal stress or pre-term labor. We are so relieved. I know we are not out of the woods, but it does feel like the worst part is over. I know you have another u/s coming up. I hope yours goes well and you get the thumbs-up from your doctor. Let me know how it goes! Good luck!

 

Jennifer - September 26

I am 30 weeks along and it was established at aprox 16 weeks that I did not have fusion. I had extensive testing amnio etc. and it was determined that my baby had a cleft lip and palate. All gentic testing came back negative. After an apoint. this morning the doctors explained that the baby was low wieght and I had low amniotic fluid levels. They spoke with myself and my partner about early delivery and the possibility of fetal death. Information available is so limited and the Drs are just now expressing serious concerns. I'm so glad to have found the two of you corresponding. I'm terrified and looking for any resourses. I do wish that I would have been more proactive in demanding more information from DRs.

 

Alison - September 26

Hello CK, congrats on the findings from your Level II U/S! I am tickled for you. So, your doc still wants you to be prepared for preterm labor just as a precaution? Sounds reasonable. My U/S is Thurs. at 8:30 and I can't get there fast enough. I faxed my OB the papers from the studies you gave me today so she could review them so we could talk according to whatever the U/S shows. Hopefully, I will have fusion now as well and we won't have to be anymore worried than we have been. I'm praying everything looks, measures, and functions as it should. At this point, who cares about finding out the s_x as long as this baby is healthy. The anxiety of not knowing is the worst feeling. So, as for seeing your OB more frequently, does that mean you will begin from once a month to every two weeks then to every week sooner or even more frequently than that? By the way, I don't think I ever told you how sorry I was to hear about your baby girl. I can't imagine how difficult that must have been for you. Thank you for sharing that with me. To Jennifer- Did your early U/S show that you did not have fusion or did this happen later after your amnio and do you still not have fusion? I am so sorry to hear of your circ_mstances and wish you and your baby the very best. Has your doctor given you any indication that all of this is linked and if at 16 weeks when you found out that you had the amnion/chorion fusion problem did your physician indicate to you any other problems at the time or were cleft lip and palate issues that arose later? I know how relieved I was when CK responded to my inquiry and the studies she posted for me to look into have been quite helpful. My thoughts and prayers are with you in these coming days.

 

CK - September 27

Jennifer - I am so sorry to hear of your news. I sort of remember hearing somewhere that cleft palate was something that could be repaired by surgery, but I really don't know. I'm sure the doctors and genetic counselors are giving you lots of information right now. When we went through our loss earlier this year due to hypoplastic left heart syndrome, I found the Babycenter bulletin boards a great source of comfort and information. Here is a link to the "grief and loss" section (if you think it might be helpful), and then you can look through to see which BBs might be best for your situation: http://www.babycenter.com/pregnancy/pregnancygrief/index. When it came down to it, though, it really was just my DH and I trying to sort through all of the information and our feelings and emotions. I hope that at 30 weeks along they can try to do as much as they can. If not, I can tell you through personal experience that sometimes letting go, although horribly difficult, is better than allowing your child to suffer for the rest of their lives. I know my comment may be way out of line and not appropriate in your situation, but I just want you to know there are others out there who have lost there very much loved little baby, and you may find some comfort in seeking out their support. I wish you all the best and will be thinking about you. Alison, good luck with your upcoming ultrasound. Please let me know how it goes and try to think positive.

 

Jennifer - September 28

We found out about the non-fusion before the amnio. The non-fusion is what prompted the Dr to suggest the amnio. After meeting with the specialist yesterday the problem is basically that we have unbilical blockage preventing the baby from getting what he needs. He is about 2lbs underweight at this point and they want to keep him in my belly as long as possible. We're aiming for 34 weeks and the Drs seem confident that we can make this happen. Aside from the cleft lip and palate which are repairable the docs say he appears to be a really tiny but healthy baby boy. After his birth he will be examined by genetic specialists to determine if there are any other midline abnormalities a__sociated with these other problems. It is strange and somewhat painful to me that my body has not been a healthy environment for my child but his father and I are full of hope and faith, and ready to fight with and for him when he gets here. All of the genetic testing that we have had so far has been negative so we are confident the cleft are isolated. I wish to continue corresponding, in 5 months this is the closest I've come to being comfortable with the vulnerability a__sociated with such situations. I wish both of you the best of luck.

 

Alison - October 3

Hey CK, I wanted to let you know we went for our second U/S on the 29th and my OB says the baby looks great. I have now completely fused. We are having a GIRL! and she measures exactly on target and her heart looks wonderful. The only thing my OB mentioned was that since we did know that I did have the late fusing that we would do another ultrasound at 32 weeks to measure her growth rate. She said the only thing she could not completely rule out was the risk of Downs with the U/S but at 32 weeks Downs babies show a slower growth rate. She offered us the additional testing if we wanted but a__sured us that she saw nothing that should be of any concern to us or her. So, I feel somewhat relieved and in the back of my mind the Downs scenario comes around sometimes but I keep telling myself that my Doc said really, she is not worried about that. Did your doctor mention this specifically to you?

 

CK - October 8

Hi to both of you. It sounds like both of you have had the best news possible for each of your situations. Jennifer, I had a lot of guilt and second-guessing with our last pregnancy about whether I had somehow caused the heart problem: was it my age (I was then 33)? Did expose myself to something toxic? Was it our house? It was especially confusing knowing that our DS was perfectly normal. That being said, his good health and relatively complication-free pregnancy gave me hope and the doctors rea__sured me that this condition was just a fluke and nothing I could have caused. Some pregnancies are just not meant to be, as much as we loved and wanted our angel DD. As difficult as it is to hear all of this information about your son, information is power, and now you and your doctors can be prepared to handle all of these situations. You sound like you are used to taking charge, so now at least you can start to take charge of your son's health before he even makes his appearance. Two of my good friend each delivered their sons 4 weeks early and, although they did not have the other complications, both are now 2 1/2 and perfectly healthy and happy little guys. Hang in there and know that all of this love and knowledge will only help your son. I have a 2 1/2 year old son and he is the light of my life. I'm sure once your son is here and you have addressed his health issues head on, you will never be able to imagine life without him!! Alison - I am so pleased to hear your good news. Our pg also seems to progressing in an otherwise normal fashion, but we will be getting checks on weight and growth, too. My peri mentioned that while the other severe chromosomal problems, such as Trisomy 18 and 13, could be visualized with a Level II u/s at this time, it was more difficult with Downs b/c the deformaties are not as obvious. He said that my blood tests, coupled with what he saw at the u/s, left us with a 98% chance of not having DS. My peri is VERY cautious and aggressive, so that was good enough for us. And congrats on the news that it is a little girl!! We don't know the s_x - we like the surprise at the delivery, so we will have to wait another 16 weeks to find out !! Good luck to us all and let's stay in touch - CK

 

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