BACKGROUND: Postprocedural amniotic band disruption sequence is a condition that 
is associated with intrauterine interventions, and it is characterized by a 
constriction of the limbs or umbilical cord by fibrous strands, leading to 
edema, amputation, and/or fetal demise.
OBJECTIVE: To evaluate the prevalence of, risk factors for, and the outcome of 
postprocedural amniotic band disruption sequence after fetoscopic laser surgery 
in twin-twin transfusion syndrome cases.
STUDY DESIGN: All consecutive cases of twin-twin transfusion syndrome treated 
with fetoscopic laser coagulation of the vascular anastomoses at our center 
between January 2002 and March 2019 were included in the study. The occurrence 
of postprocedural amniotic band disruption sequence in these cases was recorded, 
and the potential risk factors were analyzed.
RESULTS: Postprocedural amniotic band disruption sequence was detected, at 
birth, in 2.2% (15/672) of twin-twin transfusion syndrome cases treated with 
fetoscopic laser surgery, in both the recipients (10/15, 67%) and the donors 
(5/15, 33%). Postprocedural amniotic band disruption sequence primarily affected 
the lower extremities (11/15, 73%) and, less frequently, the upper extremities 
(2/15, 13%), both the upper and lower extremities (1/15, 7%), or the umbilical 
cord (1/15, 7%). Postprocedural amniotic band disruption sequence led to the 
amputation of toes in 5 of 15 cases (33%) and resulted in fetal demise because 
of constriction of the umbilical cord in 1 case (7%). The independent risk 
factors identified for postprocedural amniotic band disruption sequence were 
lower gestational age at laser surgery (odds ratio per week, 1.43; 95% 
confidence interval, 1.12-1.79; P=.003) and the presence of postprocedural 
chorioamniotic membrane separation on antenatal ultrasound examination (odds 
ratio, 41.66; 95% confidence interval, 5.44-319.25; P<.001).
CONCLUSION: The prevalence of postprocedural amniotic band disruption sequence 
is low, but, when present, it may lead to severe consequences, with amputation 
of extremities or fetal demise occurring in more than one-third of the cases. 
Lower gestational age at the time of laser therapy and chorioamniotic membrane 
separation are independent risk factors for the postprocedural amniotic band 
disruption sequence.