Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases

Hirata, Go; Aoki, Shigeru; Sakamaki, Kentaro; Takahashi, Tsuneo; Hirahara, Fumiki; Ishikawa, Hiroshi

doi:10.3109/14767058.2015.1095880

Cited by 19 publications

(31 citation statements)

References 10 publications

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“…PAC can be released by hCG directly via stimulation of the luteinizing hormone receptor expressed in the adrenal gland. 15 Elevated hCG level is seen in Ballantyne syndrome, 2 as was seen in the present case. However, it is unknown whether the elevated hCG level plays a role in the clinical manifestations of Ballantyne syndrome via stimulation of PAC release.…”

Section: Discussionsupporting

confidence: 75%

“…Ballantyne syndrome, also called mirror syndrome, is characterized by triple edema, including fetal and placental hydrops and maternal edema. 1,2 Other clinical signs include hypertension (in 57-78% of patients), proteinuria (20-56%), pulmonary edema (21%), and intrauterine fetal death (56%), as described in a previous review by Braun et al 1 Triple edema occurs regardless of the etiology underlying fetal hydrops, including rhesus isoimmunization, twin-twin transfusion syndrome, viral infection and fetal malformations, and fetal or placental tumors. 1 As excessive water retention is a cardinal sign of Ballantyne syndrome and as pulmonary edema with dyspnea can be considered as a sign associated with heart failure, aberrant water metabolism may be involved in the pathogenesis leading to altered cardiac morphology as well as function.…”

Section: Introductionmentioning

confidence: 94%

“…1,2 Other clinical signs include hypertension (in 57% -78% of patients), proteinuria (20% -56%), pulmonary edema (21%), and intrauterine fetal death (IUFD) (56%), as described in a previous review by Braun et al. 1 Triple edema occurs regardless of the etiology underlying fetal hydrops, including rhesus isoimmunization, twin-twin transfusion syndrome, viral infection and fetal malformations, and fetal or placental tumors.…”

Section: Introductionmentioning

confidence: 97%

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Echocardiography findings in a case with Ballantyne syndrome

Suzuki

Yamamura

Kikuchi

et al. 2016

J of Obstet and Gynaecol

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Marked fluid retention occurs in Ballantyne syndrome, but few reports are available on changes in cardiac morphology in this syndrome. A woman with generalized edema, dyspnea, fetal hydrops (skin edema and ascites), thickened placenta, and elevated plasma BNP level (344 pg/mL) was admitted to our hospital at gestational week (GW) 20-3/7. Blood pressure remained within the normal range. However, acute increases in left atrial volume index, pulmonary artery systolic pressure, and hyperdynamic left ventricular function (as evidenced by increased left ventricular ejection fraction to 74% with cardiac index of 5.1 L/min/m 2 ) occurred preceding fetal death at GW 21-4/7 in the presence of increased inferior vena cava diameter (23 mm) and relatively low systemic vascular resistance of 752 dyn·s/cm 5 . These findings suggested life-threatening heart failure and required cesarean delivery at GW 21-5/7 resulting in complete recovery. The placenta suggested cytomegalovirus infection.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 97%

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Echocardiography findings in a case with Ballantyne syndrome

Suzuki

Yamamura

Kikuchi

et al. 2016

J of Obstet and Gynaecol

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“…Elevated levels of hCG and sFlt-1 were shown to be associated with Ballantyne syndrome:2 14 15 maternal serum hCG level is significantly higher for hydropic infants with Ballantyne syndrome than those without (453 000 vs 80 000 IU/L, respectively);2 median (range) plasma sFlt-1 level is significantly higher for mothers with Ballantyne syndrome than those without (3974 (3083–10 780) vs 824 (260–4712) pg/mL, respectively);14 and plasma sFlt-1 levels were 11 650 pg/mL in a woman with cytomegalovirus-induced Ballantyne syndrome15 and 14 117 pg/mL in a woman with parvovirus B19-induced fetal and placental hydrops 16. In addition, in the presence of placentomegaly regardless of its aetiology, elevated levels of sFlt-1 were observed in one case with triploidy (karyotype 69, XXY) at GW 14 (2953 pg/mL) and in another case with hydatidiform moles at GW 18 (4865 pg/mL) 17.…”

Section: Discussionmentioning

confidence: 99%

“…Ballantyne syndrome, also called mirror syndrome or triple oedema, is a rare disorder affecting pregnant women with presentation of fetal and placental hydrops and maternal oedema 1 2. A review of 56 reported cases1 has indicated that Ballantyne syndrome can occur in the presence of hydropic fetus regardless of its aetiology.…”

Section: Introductionmentioning

confidence: 99%

Changes in echocardiography and blood variables during and after development of Ballantyne syndrome

et al. 2016

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We report a pregnant woman who was monitored by echocardiography and determination of blood variables, including components of the renin-angiotensin-aldosterone system (RAAS), cardiac biomarkers and soluble fms-like tyrosine kinase-1 (sFlt-1), during and after the development of Ballantyne syndrome. Generalised maternal oedema with dyspnoea following fetal and placental hydrops necessitated a caesarean section at 33 weeks of gestation. Changes in blood variables and simultaneous echocardiography changes indicated acutely enhanced RAAS and hyperdynamic left ventricular function in response to excessive volume overload (as evidenced by brain-type natriuretic peptide level of 523 pg/mL) in the absence of increased systemic vascular resistance. Elevated sFlt-1 (15 600 pg/mL) and human chorionic gonadotrophin (404 000 IU/L) levels were also noted. The increased plasma aldosterone concentration (2070 pg/mL) may have been responsible for the increase in circulating plasma volume, and the increased sFlt-1 level was responsible for generalised maternal oedema. It remains unclear which factor(s) triggered RAAS activation.

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Maternal “mirror” syndrome: Evaluating the benefits of fetal therapy

Sichitiu,

Alkazaleh,

de Heus

et al. 2024

Prenatal Diagnosis

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ObjectiveTo evaluate maternal and perinatal outcomes following fetal intervention in the context of maternal “mirror” syndrome.Study DesignA multicenter retrospective study of all cases of fetal hydrops complicated by maternal “mirror” syndrome and treated by any form of fetal therapy between 1995 and 2022. Medical records and ultrasound images of all cases were reviewed. “Mirror” syndrome was defined as fetal hydrops and/or placentomegaly associated with the maternal development of pronounced edema, with or without pre‐eclampsia. Fetal hydrops was defined as the presence of abnormal fluid collections in ≥2 body cavities.ResultsTwenty‐one pregnancies met the inclusion criteria. Causes of fetal hydrops and/or placentomegaly included fetal lung lesions (n = 9), twin‐twin transfusion syndrome (n = 6), severe fetal anemia (n = 4), and others (n = 2). Mean gestational age at “mirror” presentation was 27.0 ± 3.8 weeks. Maternal “mirror” syndrome was identified following fetal therapeutic intervention in 14 cases (66.6%). “Mirror” symptoms resolved or significantly improved before delivery in 8 (38.1%) cases with a mean interval from fetal intervention to maternal recovery of 13.1 days (range 4–35). Three women needed to be delivered because of worsening “mirror” syndrome. Of the 21 pregnancies treated (27 fetuses), there were 15 (55.5%) livebirths, 7 (25.9%) neonatal deaths and 5 (18.5%) intra‐uterine deaths.ConclusionFollowing successful treatment and resolution of fetal hydrops, maternal “mirror” syndrome can improve or sometimes completely resolve before delivery. Furthermore, the recognition that “mirror” syndrome may arise only after fetal intervention necessitates hightened patient maternal surveillance in cases of fetal hydrops.

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Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases

Abstract: Mirror syndrome is occurred frequently in early and severe fetal hydrops and cause hemodilution and elevation of serum hCG.

Cited by 19 publications

References 10 publications

Echocardiography findings in a case with Ballantyne syndrome

Echocardiography findings in a case with Ballantyne syndrome

Changes in echocardiography and blood variables during and after development of Ballantyne syndrome

Maternal “mirror” syndrome: Evaluating the benefits of fetal therapy

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