Diagnosis and treatment of 15 cases with mirror syndrome

Abstract

Objective To discuss the clinical features, diagnosis and therapy of mirror syndrome. Methods Clinical data of 15 cases with mirror syndrome admitted to the Six Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2015 were retrospectively analyzed. Results (1) Etiology: In fifteen cases of mirror syndrome, 14 cases were Bart′s hydrops fetalis, and l case was unknown etiology. (2) Clinical manifestation: In the 15cases, 5 cases presented oliguria, 3 cases presented elevated blood pressure, 2 cases presented stomach pain, l cases presented headache. (3) Laboratory findings: All the patients presented anemia, hemodilution, hypoproteinemia, and elevated D-Dimer. Five cases presented elevated creatinine, 13 cases presented elevated uric acid and 13 cases presented acidosis. (4) Ultrasonography and pathological examinations: Fetal ultrasound of the 15 fetuses revealed hydrops fetalis, and the placenta thickness was [mean (70.87±14.12)] mm. The pathological examination of placenta indicated edematous in 15 cases. (5)Maternal complications: 12 cases had postpartum hemorrhage, 6 cases had placenta adhesion, 5 cases had acute kidney failure, 3 cases had acute heart failure, 2 cases had acute pulmonary edema, 1 case had placental abruption, 1 case had amnionic fluid embolism, 1 case had disseminated intravascular coagulation, 1 case had metabolic encephalopathy. Conclusions Maternal edema with hydrops fetalis and/or hydropic placenta could be diagnosed as mirror syndrome. Except for preeclampsia-like manifestation, it had the feature of maternal hemodilution. When the patient was diagnosed as mirror syndrome and the condition out of control, pregnancy should be terminated as soon as possible. Key words: Placental insufficiency; Hydrops fetalis; Pre-eclampsia; Pregnancy outcome