Mirror Syndrome in Pregnancy: "Two Patients-ONE Disease"
Title: Mirror Syndrome in Pregnancy: "Two Patients-ONE Disease"
- Describe how mirror syndrome affects the pregnant patient.
- Describe how mirror syndrome affects the fetus.
- Describe the treatment for mirror syndrome.
Background: This presentation describes the management of a patient who was transferred to us at 27 weeks gestation for severe preeclampsia, but ended up being diagnosed with Mirror Syndrome.
Case: She complained of flu- like symptoms lasting 3 days, headache and decreased fetal movement. Signs and symptoms included hypertension, oliguria, proteinuria, pitting edema and abnormal lab values. Acute right-sided abdominal pain developed during transfer. The pregnancy was known to be complicated by hydrops, ascites and multiple fetal anomalies thought to be incompatible with life.
She was treated with Magnesium Sulfate, anti-emetics, narcotic pain control, and IV hydration. A 24 hour urine collection and PIH labs were initiated. MRI and a surgical consult were also ordered to rule out appendicitis. MRI verified mild anasarca within the abdomen and pelvis, but the appendix was not adequately visualized.
The 24 hour urine had nearly 5 grams of protein. The patient became increasingly uncomfortable with bilateral 3+ pitting edema from her feet up through her thighs. Induction was recommended due to worsening maternal status, and the potential for other morbidities associated with Mirror Syndrome. Fetal paracentesis of 600 ML was performed to facilitate vaginal breech delivery. A stillborn baby girl with multiple anomalies, generalized edema and ambiguous genitalia, was delivered weighing 3lb 2 oz. Magnesium sulfate continued post partum for 24 hours. The post partum course was unremarkable, and the patient was discharged 48 hours after delivery.
Conclusion: First described in 1892 by John W. Ballantyne, Mirror Syndrome is a preeclamptic -like disease characterized by fetal or placental hydrops, maternal anemia, edema, hypertension, liver dysfunction, and poor fetal outcome. It is called Mirror Syndrome because the maternal pathology mirrors that of the fetus. This is a rare condition whose etiology is not known. Fewer than 25 cases were reported in the literature prior to 2007 (Braun, T et al). Some of the potentially critical maternal sequelae of Mirror Syndrome include pulmonary edema, ARDS, pericardial effusions and renal failure. Careful evaluation is needed to differentiate between preeclampsia and Mirror Syndrome, because the maternal morbidity may be more extensive.
Keywords: Mirror Syndrome, preeclampsia, ascites, hydrops