Clinical Presentation and Outcome of 10 Cases of Mirror Syndrome [3P

Abstract

INTRODUCTION: Mirror syndrome, or Ballantyne’s syndrome, is a rare diagnosis with only 113 cases described in the literature. It is mainly characterised by maternal symptoms similar to preeclampsia in the setting of fetal hydrops. We identify 10 additional cases and provide a review of the maternal presentation, biochemical findings and perinatal outcome. METHODS: We performed a retrospective chart review of all cases of fetal hydrops from two tertiary centers in Winnipeg, Canada between 2000 and 2016. There were 276 cases of fetal hydrops during this period, of which 10 cases satisfied the criteria for Mirror syndrome. RESULTS: We report 10 cases of Mirror syndrome. The majority (80%) of women were multiparous. The mean gestational age at diagnosis was 23 weeks 4 days +/- 4 days and the mean gestational age at delivery was 25 weeks +/- 5 days. The most common clinical findings included hypertension, edema and placentomegaly. The most common laboratory findings included hypoalbuminemia (mean 20 7 gm/L), elevated uric acid level (mean 375 µmol/L) and anemia (mean hemoglobin 10g/dL). Half of the fetuses were stillborn and 40% of pregnancies resulted in neonatal deaths. Congenital anomalies were diagnosed in half of the pregnancies. CONCLUSION: Mirror Syndrome is likely under-diagnosed. Acute hemodilution, hypoalbuminemia and hyperuricemia might be early indicators for the diagnosis. Delivery is the treatment of choice and maternal symptoms usually resolve within few days after delivery. Fetal outcome is poor but early recognition may potentially avoid maternal morbidity.