Objective:

To report two rare cases of Pseudoamniotic Band Syndrome (PABS) occurring after invasive fetal interventions and to review the clinical characteristics of PABS in Twin-to-Twin Transfusion Syndrome (TTTS).

Approach:

• Case Reports: Described two cases of PABS: one after TTTS fetoscopic surgery and one after microwave ablation and amniocentesis, both treated with fetoscopic band release.
• Literature Review: Conducted a review of 50 reported PABS cases after TTTS treatment, comparing expectant management with fetoscopic release.

Key Findings:

• Both reported cases of PABS were successfully treated with fetoscopic band release.
• PABS predominantly affected recipients in TTTS (78.0%) and primarily involved fetal limbs (88.2%).
• Antenatal detection of PABS was low (20.0%), with a 9.5% rate of fetal limb amputation without intervention.
• Only 8 cases of PABS in TTTS have undergone fetoscopic release, with a median gestational age of 23.5 weeks at the time of surgery.

Interpretation:

Fetoscopic band release appears technically feasible in twin pregnancies, although evidence is limited.

Limitations:

• Antenatal diagnosis of PABS remains challenging.
• The evidence is limited and may be influenced by publication bias.

Conclusion:

Serial ultrasound surveillance after fetal interventions should include PABS assessment, particularly 4 weeks post-procedure.