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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
“Mirror syndrome,” also known as “Ballantyne's syndrome,” is a rare complication of NIH in which edema develops in the mother that mirrors the hydropic fetus. The exact underlying pathogenesis is unknown, but this condition is characterized by edema and pre-eclampsia-like symptoms, such as weight gain and edema (84% of cases), hypertension (60.1%), anemia/hemodilution (51.3%), dyspnea or pulmonary edema (30%), transaminitis (19.4%), and oliguria (15%) [44]. The incidence of mirror syndrome is so low that the distinction between mirror syndrome and pre-eclampsia has been difficult to assess. In a review of 113 cases from 1956–2016 [44], the average age of diagnosis was 27 ± 4.3 weeks. The median time needed for maternal symptoms to resolve was 5.5 days after delivery or successful treatment of the fetal hydrops. A total of eight cases exhibited complete reversal of maternal symptoms prior to delivery, following supportive treatment or blood transfusion. The average rate of intrauterine fetal demise was 57.9%. No cases of maternal mortality were reported. There are currently no management studies on expectant management in cases of mirror syndrome. In some cases of NIH with a potentially treatable etiology, resolution of maternal symptoms has been seen after fetal treatment. Caution is advised in these situations and delivery should not be delayed in the case of worsening maternal status. In most cases of mirror syndrome, delivery is recommended [1].
Fetal surgery
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Hydrops in a fetus can occur with any condition that compresses the main veins and thereby reduces the venous return to the heart. It can also occur in a high-output state where the venous return is more than the heart can take. The fetus develops anasarca, which can lead to fetal demise. Similar changes may be seen in the mother and this condition is called maternal mirror syndrome. Maternal mirror syndrome is defined as a severe pre-eclamptic state with hypertension, proteinuria, elevated liver enzymes, thrombocytopenia, ankle and pedal oedema or even generalised fluid retention. Common conditions that may lead to hydrops are CCAM, CDH, SCT and large mediastinal masses.
Multiple pregnancy
Published in Louise C Kenny, Jenny E Myers, Obstetrics, 2017
TAPS is a rarer chronic form of TTTS in which a large inter-twin haemoglobin difference occurs but the oligohydramnios polyhydramnios sequence that is observed with TTTS is not seen. It is thought to occur from residual small (<1 mm) unidirectional AV anastomoses without accompanying AA anastomoses. The small residual anastomoses lead to the gradual development of anaemia in one twin and polycythaemia in the other twin. As the vessels are small, this allows haemodynamic compensation, which is thought to be why the characteristic oligohydramnios polyhydramnios pattern does not occur. Severe polycythaemia can occur, leading to fetal and placental thrombosis and hydrops fetalis in the anaemic twin. Rarely, mirror syndrome, the combination of fetal hydrops and maternal pre-eclampsia, has been reported.
Clinical characteristics of mirror syndrome: a retrospective study of 16 cases
Published in Journal of Obstetrics and Gynaecology, 2021
Ruiyun Chen, Min Liu, Jianying Yan, Fengyi Chen, Qing Han, Lianghui Zheng, Yulong Zhang, Jinying Luo, Lichun Chen, Hongfei Liu, Lu Yu
Usually, foetal hydrops is associated with a very poor foetal prognosis, and pregnant women who develop mirror syndrome may show preeclampsia and pulmonary oedema and may have a high rate of postpartum haemorrhage. The challenges in the management of this condition include establishment of its aetiology, determination of the most appropriate therapy, decisions of the timing and mode of delivery and prevention of further disease progress. In addition, the precise clinical features need to be disclosed. The aim of this study was to analyse the clinical features of mirror syndrome, including the aetiology, clinical characteristics, complications and maternal outcomes.
Pitfalls in the assessment of gestational transient thyrotoxicosis
Published in Gynecological Endocrinology, 2020
Some patients have mirror syndrome complicated by thyrotoxicosis [56,57], which may be caused by excessive hCG production, because abnormal hCG has an even greater thyroid-stimulating ability than normal hCG. Maternal symptoms of mirror syndrome are likely to emerge beyond the second trimester and disappear shortly after the fetal symptoms have been successfully treated or the pregnancy has been terminated [58]. Therefore, the onset of thyrotoxicosis in this condition might be later than that in typical GTT. Assessing maternal hCG levels and thyroid function should be part of the evaluation of fetal hydrops associated with mirror syndrome.