Mirror Syndrome in Pregnancy: Two Patients, One Disease

Abstract

Childbearing Poster Presentation Background First described in 1892 by John W. Ballantyne, Mirror Syndrome is a preeclampsia‐like disease characterized by fetal or placental hydrops, maternal anemia, edema, hypertension, liver dysfunction, and poor fetal outcome. It is called Mirror Syndrome because the maternal pathology mirrors that of the fetus. This is a rare condition whose etiology is not known. Some of the potentially critical maternal sequelae of Mirror Syndrome include pulmonary edema, adult respiratory distress syndrome, pericardial effusions, and renal failure. Case A patient was transferred to us at 27‐week gestation for severe preeclampsia but was later diagnosed with Mirror Syndrome. The patient complained of flu‐like symptoms lasting 3 days, headache, and decreased fetal movement. Signs and symptoms included hypertension, oliguria, proteinuria, pitting edema, and abnormal lab values. Acute right‐sided abdominal pain developed during transfer. The pregnancy was known to be complicated by hydrops, ascites, and multiple fetal anomalies thought to be incompatible with life. She was treated with magnesium sulfate, antiemetics, narcotic pain control, and intravenous hydration. A 24‐hour urine collection and pregnancy‐induced hypertension labs were initiated. A magnetic resonance imaging (MRI) scan and a surgical consult were ordered to rule out appendicitis. The MRI verified mild anasarca within the abdomen and pelvis, but the appendix was not adequately visualized. The 24‐hour urine had nearly 5 grams of protein. The patient became increasingly uncomfortable with bilateral 3+ pitting edema from her feet through her thighs. Induction was recommended due to worsening maternal status, and the potential for other morbidities associated with Mirror Syndrome. Fetal paracentesis of 600 ml was performed to facilitate vaginal breech delivery. A stillborn female infant with multiple anomalies, generalized edema, and ambiguous genitalia was delivered weighing 3 pounds 2 ounces. Magnesium sulfate continued postpartum for 24 hours. The postpartum course was unremarkable, and the patient was discharged 48 hours after delivery. Conclusion Careful evaluation is needed to differentiate between preeclampsia and Mirror Syndrome because the maternal morbidity may be more extensive.