Mirror syndrome: a systematic literature review

Biswas, Sonia; Gomez, Julie; Horgan, Rebecca; Sibai, Baha M.; Saad, Antonio F.; Powel, Jennifer E.; Al‐Kouatly, Huda B.

doi:10.1016/j.ajogmf.2023.101067

Cited by 9 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, this disorder is often misdiagnosed because of preeclampsia-like manifestations. Differentiating between MS and preeclampsia-like syndromes may be difficult, and the only difference lies in fetal edema, which is present in MS [ 12 , 13 ]. Our case demonstrated a larger chorioangioma, which was 8.5 cm in diameter, and the patient presented with severe pulmonary edema, progressive lower leg edema and hydrops fetalis.…”

Section: Discussionmentioning

confidence: 99%

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

Wu,

Huang,

Tsai

et al. 2024

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Ritodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma. Case presentation A 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation, with an undiagnosed placental chorioangioma, underwent tocolysis due to preterm uterine contractions. Her clinical condition deteriorated, attributed to mirror syndrome and adverse events induced by ritodrine. An emergency cesarean section was performed at 27 1/7 weeks of gestation, delivering an infant with generalized subcutaneous edema. A placental tumor measuring 8.5 cm was discovered during the operation, and pathology confirmed chorioangioma. Gradual improvement in her symptoms and laboratory data was observed during the postpartum period. Identifying mirror syndrome and ritodrine-induced side effects poses challenges. Therefore, this case is educational and warrants discussion. Conclusion Our case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload.

show abstract

Section: Discussionmentioning

confidence: 99%

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

Wu,

Huang,

Tsai

et al. 2024

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…A specific but uncommon obstetrical complication of hydrops fetalis is mirror syndrome (Ballantyne's syndrome) where the pregnant person develops symptoms that emulate fetal hydrops, in particular edema. 67 Pathophysiology is poorly understood, but it may be a form of preeclampsia in which the hydropic placenta initiates a systemic inflammatory response causing an increase in trophoblastic debris into maternal blood. 68 Mirror syndrome infers risks of postpartum hemorrhage, intensive care unit admission, heart failure, pulmonary edema, renal dysfunction, stillbirth, and neonatal death.…”

Section: Postnatal Managementmentioning

confidence: 99%

“…A recent literature review suggests that the most common etiologies of fetal hydrops associated with mirror syndrome include structural cardiac malformations, alpha thalassemia, Rh isoimmunization, and nonimmune hydrops fetalis. 67 Hydrops fetalis carries a high risk of perinatal mortality. Rates of miscarriage and stillbirth are high.…”

Section: Postnatal Managementmentioning

confidence: 99%

Hydrops fetalis: Incidence, Etiologies, Management Strategies, and Outcomes

Younge,

Ottolini,

Al-Kouatly

et al. 2023

RRN

View full text Add to dashboard Cite

Hydrops fetalis describes a pathologic over accumulation of fluid affecting multiple organs of the fetus or neonate. It is a rare condition with numerous etiologies, including many rare diseases. Causes of hydrops fetalis vary regionally based on prevalence of inheritable conditions and availability of RhD immune globulin to prevent immune hydrops fetalis. In some instances, the etiology remains unknown despite extensive evaluation. Overall, the prognosis is extremely poor, but it is also extremely variable and full recovery is possible. Prenatal management includes evaluation to determine etiology, which can provide prognostic value for counseling and medical decision-making. Diagnostic work-up often includes genetic testing with increasing evidence supporting the use of exome sequencing. Depending on the etiology, targeted therapies may be available or in development. Postnatal management emphasizes supportive care as diagnostic work-up continues. Perinatal palliative care plays an essential role for families affected by this challenging condition.

show abstract

“…16,17 We identified a trend for postpartum pre-eclampsia in the setting of NIHF; prior studies have mostly reported antepartum onset of hypertensive disorder or mirror syndrome, with 75% of cases resolved by 7 days postpartum. 7 The risk of postpartum pre-eclampsia emphasizes the importance of postpartum care and health insurance coverage. Mirror syndrome was not diagnosed in any case.…”

Section: Admissions From Hypertensionmentioning

confidence: 99%

“…6 Mirror syndrome is another reported obstetric complication of hydrops fetalis, marked by generalized edema (62%), hypoalbuminemia (55%), hypertension (39%), and anemia (39%). 7 Preterm birth and cesarean delivery also occur more often in NIHF pregnancies. 2,8 Additionally, pregnancies with hydrops fetalis experience higher rates of postpartum hemorrhage (PPH), blood transfusion, and polyhydramnios.…”

Section: Introductionmentioning

confidence: 99%

Maternal outcomes of a cohort of pregnancies affected by non‐immune hydrops fetalis

Critchlow,

Wodoslawsky,

Makhamreh

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

ObjectiveTo describe the maternal outcomes of a prospective cohort of non‐immune hydrops fetalis (NIHF) pregnancies with negative standard‐of‐care evaluations.MethodsThis study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work‐ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre‐eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health.ResultsForty pregnancies were included. Four patients developed pre‐eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5 (13.5%) cases of postpartum hemorrhage and an additional 3 (8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new‐onset or exacerbated depression or anxiety symptoms.ConclusionOur study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard‐of‐care evaluations, including a high rate of postpartum pre‐eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.

show abstract

Mirror syndrome: a systematic literature review

Cited by 9 publications

References 27 publications

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

Hydrops fetalis: Incidence, Etiologies, Management Strategies, and Outcomes

Maternal outcomes of a cohort of pregnancies affected by non‐immune hydrops fetalis

Contact Info

Product

Resources

About