A newborn internal and external malformations.

To cite: Mascarenhas MI, Ferreira M, Miguens J, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-009566 DESCRIPTION We presented a case of a female newborn (NB), the fifth daughter of healthy non-consanguineous parents. It was an uneventful biamniotic bicorionic pregnancy except for a prenatal diagnosis of a right clubfoot of the first twin at the 16th week of gestation. A caesarean section was performed at 36-week gestation: the first twin was found to be involved by amniotic adhesions and the skin overlying the right knee was attached to the uterine wall. She also presented an amniotic band constricting the second and third fingers, a malformation of the right lower limb (shortness of the limb and a pterygium between foot dorsum and leg) and a caudal appendage (figures 1 and 2). She was admitted to the neonatal intensive care unit for surveillance. A cranial and spinal MRI was performed and confirmed a spina bifida occulta (figure 3). Further investigation revealed no abdominal, renal or cardiac malformation. Chromosomal analysis was normal. The second twin showed no malformations. Amniotic band syndrome has an incidence of 1:1200–1500 NB and can result in various body malformations due to constriction bands with interference in fetal development. Spinal bifida oculta associated to caudal appendage is due to a failure in the secondary neurulation or segmentation process, which occurs in the first weeks of gestation. Presently, at 3 years of age she is unable to walk due to the right limb malformation and has