Intrauterine Adhesion Band Causing Fetal Leg Compression: A Case Report of a Rare Asherman Syndrome Complication in Pregnancy.

Abstract

Asherman syndrome (AS), characterized by intrauterine adhesions, can lead to various pregnancy complications. We report a case of a 31-year-old woman who was admitted at 29+2 weeks due to preterm premature rupture of membranes at our university hospital. The woman had a history of AS following emergency curettage. Ultrasonography revealed an adhesion band in the lower uterine segment, closely positioned to the fetus's leg. Antibiotic therapy and antenatal corticosteroids were administered to prevent infection and neonatal respiratory distress syndrome. Two weeks later, the woman developed labor contractions and pathological cardiotocography, leading to a secondary cesarean section. During surgery, the fetus was found to be in an incomplete breech position, with one leg trapped beneath the adhesion band. Delivery was achieved by releasing the other leg and cutting the adhesion band. The neonate was born with significant right leg edema, likely due to chronic intrauterine compressionby the adhesion band. Postoperatively, the neonate required intensive care. Regular orthopedic visits confirmed intact circulation, sensory, and motor function of the leg and the edema gradually resolved. This case highlights a rare pregnancy complication due to an intrauterine adhesion band and emphasizes the importance of accurate and early adhesion band detection such as the differential diagnostic exclusion of the more common amniotic band via ultrasound. It is a good example of multidisciplinary care provided by obstetricians, neonatologists and orthopedic surgeons in a perinatal care center.