Mirror Syndrome: A Rare, Potentially Life‐Threatening Obstetric Complication

Abstract

Poster Presentation Background Mirror syndrome is a rare, potentially life‐threatening obstetric complication characterized by the development of maternal edema, hypertension, and proteinuria in association with fetal hydrops. Hydrops is diagnosed when there is accumulation of fluid in at least two fetal compartments. The maternal condition mirrors the edema present in the fetus and/or the placenta. Documented cases of mirror syndrome have been associated with fetal infections and malformations. We review the nursing care of a pregnant woman who developed mirror syndrome secondary to a fetal diagnosis of sacrococcygeal teratoma (SCT). Sacrococcygeal teratomas are one of the most commonly diagnosed newborn tumors (1:40000) and arise from the sacrococcygeal region. They can be internal, external, solid, cystic, or a combination. Close surveillance of the mother and fetus is necessary as large solid tumors can result in fetal cardiac compromise and the development of hydrops. Hydrops increases the risk of fetal mortality and maternal morbidity. Case A 23‐year‐old G3P1011 presented for initial evaluation at 26 weeks 4 days gestation. A large mass consisting of solid and cystic components arising from the sacrum was identified on fetal ultrasound and magnetic resonance imaging (MRI). The estimated overall volume of the tumor was 642 ml. Placentomegaly was present. The plan for obstetric management included twice weekly fetal ultrasound surveillance and maternal evaluation. The planned mode of delivery would be cesarean with immediate neonatal SCT resection at 32 weeks gestation. Ultrasound at 31 weeks 1 day indicated an overall SCT volume of 1604 ml with continued placentomegaly but no additional evidence of fetal hydrops. Maternal assessment indicated elevated blood pressure, trace proteinuria, hyperreflexia, and slightly elevated liver enzymes. The woman was otherwise asymptomatic and admitted for observation. Laboratory studies showed increasing liver enzymes, and a cesarean birth was performed at 31 weeks 4 days gestation for impending mirror syndrome. The neonate was stabilized and transferred to an adjoining operating room where she underwent immediate resection of the tumor. The woman's symptoms resolved, and she was discharged within 72 hours. Conclusion Nurses were ideally suited to provide family‐centered and holistic care to this woman and her family. Nurses with varying areas of expertise participated in the care of this maternal/newborn dyad. Throughout the pregnancy, nurses were an integral part of the multidisciplinary team that provided clinical care, education, and psychosocial support. Comprehensive maternal assessment and evaluation resulted in the timely diagnosis and prompt intervention for mirror syndrome.