Mirror Syndrome: A Reflection of Fetal Health

Abstract

Background Mirror syndrome was first described as a clinical occurrence in 1892 by John Ballantyne in which nonimmune hydrops fetalis complicates the pregnancy. Maternal edema and other complications including preeclampsia mirror the hydrops noted in the fetus. The purpose of this case presentation is to familiarize the perinatal nurse with this rare complication of pregnancy and to describe the ethical dilemma of immediate delivery versus postponing delivery due to extreme prematurity. Case Three weeks after the diagnosis of nonimmune hydrops fetalis secondary to a large sacrococcygeal tumor, the woman at 24 weeks 5 days gestation presented with severe bilateral lower extremity edema. On admission the woman was noted to have severe range blood pressures, proteinuria, and epigastric pain. Laboratory data also revealed elevated liver enzymes, severe anemia with hemoglobin of 5.0 and hematocrit of 15.3, and thrombocytopenia. Ultrasound and magnetic resonance imaging (MRI) studies revealed worsening nonimmune hydrops fetalis and a significant increase in the size of the sacrococcygeal tumor rivaling the size of the fetus. The woman was immediately started on mjagnesium sulfate, labetalol, betamethasone, and blood replacement products. Several consults were performed with neonatology, pediatric surgery, hematology, and maternal/fetal medicine. The maternal/fetal medicine team assumed care of the woman and encouraged immediate delivery. The woman and her family wanted to continue the pregnancy until 28 weeks to allow for additional maturity of the fetus. Discussions ensued outlining the risks for the mother and to the fetus of continuing the pregnancy. Conclusion At this point the mother continued to refuse delivery. An ethicist was called in to assist and described the four fundamental principles of ethics, beneficence, autonomy, nonmaleficence, and justice, and their relationship to this case. After 2 days of hospitalization the woman relented and a cesarean was performed. The mother needed additional blood products but was discharged to home after 6 days. The newborn underwent emergency surgery to remove the tumor, however, she succumbed to heart failure during the postoperative period. Mirror syndrome was first described as a clinical occurrence in 1892 by John Ballantyne in which nonimmune hydrops fetalis complicates the pregnancy. Maternal edema and other complications including preeclampsia mirror the hydrops noted in the fetus. The purpose of this case presentation is to familiarize the perinatal nurse with this rare complication of pregnancy and to describe the ethical dilemma of immediate delivery versus postponing delivery due to extreme prematurity. Three weeks after the diagnosis of nonimmune hydrops fetalis secondary to a large sacrococcygeal tumor, the woman at 24 weeks 5 days gestation presented with severe bilateral lower extremity edema. On admission the woman was noted to have severe range blood pressures, proteinuria, and epigastric pain. Laboratory data also revealed elevated liver enzymes, severe anemia with hemoglobin of 5.0 and hematocrit of 15.3, and thrombocytopenia. Ultrasound and magnetic resonance imaging (MRI) studies revealed worsening nonimmune hydrops fetalis and a significant increase in the size of the sacrococcygeal tumor rivaling the size of the fetus. The woman was immediately started on mjagnesium sulfate, labetalol, betamethasone, and blood replacement products. Several consults were performed with neonatology, pediatric surgery, hematology, and maternal/fetal medicine. The maternal/fetal medicine team assumed care of the woman and encouraged immediate delivery. The woman and her family wanted to continue the pregnancy until 28 weeks to allow for additional maturity of the fetus. Discussions ensued outlining the risks for the mother and to the fetus of continuing the pregnancy. At this point the mother continued to refuse delivery. An ethicist was called in to assist and described the four fundamental principles of ethics, beneficence, autonomy, nonmaleficence, and justice, and their relationship to this case. After 2 days of hospitalization the woman relented and a cesarean was performed. The mother needed additional blood products but was discharged to home after 6 days. The newborn underwent emergency surgery to remove the tumor, however, she succumbed to heart failure during the postoperative period.