[Mirror pre-eclampsia: Ballantyne's syndrome. Two cases]

[Mirror syndrome: literature review based on a case]

Le syndrome miroir ou syndrome de Ballantyne est une entité pathologique rare, définit par l´association d´une anasarque fœtale et d´un œdème maternel généralisé pouvant se compliquer d´une prééclampsie. L´objectif de ce travail est de mettre en exergue les particularités diagnostic et thérapeutique de cette entité clinique grave, qui, en dépit de sa rareté, ne doit pas être méconnu. Et ceux à travers la description d´un cas clinique d´une parturiente de 35 ans qui s´est présentée aux urgences, à 26 semaines d´aménorrhée, dans un tableau de syndrome miroir idiopathique dont l´évolution fut rapidement marquée par la survenue d´un décès in utéro puis régression de la symptomatologie clinico-biologique maternelle une fois la vacuité utérine obtenue. En effet, un traitement spécifique in utéro est vivement souhaitable. Quoique dans certains cas graves idiopathiques, seule l´obtention de la vacuité utérine permet l´amélioration du pronostic maternel voire fœtale.

The performance of cardio-biparietal ratio measured by 2D ultrasound in predicting fetal hemoglobin Bart disease during midpregnancy: A pilot study

OBJECTIVE

The aim of this study was to assess the performance of cardio-biparietal ratio measured by real-time two-dimensional ultrasound in predicting hemoglobin (Hb) Bart disease among fetuses at risk.

METHOD

This prospective diagnostic study recruited pregnancies at risk for Hb Bart disease at 17 to 22 weeks' gestation. Cardio-biparietal ratio and cardiothoracic ratio were measured before cordocentesis for Hb typing. The performance of the cardio-biparietal ratio and cardiothoracic ratio for identifying affected fetuses was evaluated.

RESULTS

Among 72 fetuses at risk, 31 were diagnosed as affected by Hb Bart disease. By using a cutoff 0.45, cardio-biparietal ratio had a sensitivity of 83.9%, specificity of 92.7%, positive predictive value of 89.7%, and negative predictive value of 88.4%, whereas cardiothoracic ratio using cutoff 0.5 had a sensitivity of 94.3%, specificity of 65.1%, positive predictive value of 68.8%, and negative predictive value of 93.3%.

CONCLUSION

Cardio-biparietal ratio is a new sonomarker to predict Hb Bart disease among fetuses at risk. This sonomarker is relatively effective and may be useful in areas of high prevalence of alpha thalassemia disease, limited number of experts in prenatal ultrasound, and difficult access to prenatal diagnosis.

[Ballantyne syndrome complicated by eclampsia: about a case and literature review]

Le syndrome de Ballantyne ou préeclampsie en miroir est une entité clinique rare. Son ethiopathogénie reste encore mal élucidée. Son diagnostic doit être évoqué devant un syndrome œdémateux maternel associé à un état d'anasarque fœtal. Le pronostic fœtal réservé auquel peut s'associer une forte morbidité maternelle expliquent l'intérêt de poser un diagnostic précoce en identifiant son étiologie afin d'établir un traitement anténatal pouvant améliorer ainsi le pronostic materno-fœtal. Nous rapportons et discuterons à la lumière d'une revue de la littérature, le cas d'un probable syndrome de Ballantyne secondaire à un syndrome malformatif fœtal compliqué d'éclampsie chez la mère.

[Reversal of Ballantyne's syndrome by selective fetal termination in a twin pregnancy]

OBJECTIVES

We describe Ballantyne's syndrome, a severe clinical materno-fetal entity, a pre-eclampsia-like disease.

MATERIALS AND METHODS

We report the case of a woman with twin pregnancy presenting a Ballantyne's syndrome. Ultrasound examination at 22 weeks of gestation (wg), found heart abnormalities for one of the fetus. The ultrasonographic supervision revealed a fetal hydrops and at 28 wg a generalized maternal edema picture occurred. At this time, a Ballantyne's syndrome was suspected.

RESULTS

A selective fetal termination of the affected twin was performed leading to a complete reversal of clinical and biochemical maternal picture, allowing the continuance of the pregnancy until 32 wg.

CONCLUSION

Our article illustrates that when the diagnosis of Ballantyne's syndrome is quickly suspected and a treatable cause can be found, it allows sometimes a prenatal management and improves the materno-fetal prognosis.

Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death

OBJECTIVES

The objectives were (1) to identify the causes for hydrops fetalis neonates admitted for neonatal intensive care with the diagnosis of hydrops fetalis and (2) to identify the risk factors associated with death.

METHODS

A retrospective review of a large national data set was performed.

RESULTS

There were a total of 253,651 discharges from 162 NICUs in the database; 598 patients were identified with a report of hydrops fetalis. The most common associated diagnoses were congenital heart problems (13.7%), abnormalities in heart rate (10.4%), twin-to-twin transfusion (9%), congenital anomalies (8.7%), chromosomal abnormalities (7.5%), congenital viral infections (6.7%), congenital anemia (5%), and congenital chylothorax (3.2%). Of those 598 neonates, 115 were transferred either to another hospital or to another service, 215 died before discharge, and 267 were discharged from the hospital. One patient did not have a discharge type listed and was not included in the outcome analysis. Mortality rates were highest among neonates with congenital anomalies (57.7%) and lowest among neonates with congenital chylothorax (5.9%). Factors that were associated independently with death in logistic regression analyses were younger gestational age, low 5-minute Apgar score, and need for high levels of support during the first day after birth (higher levels of inspired oxygen support and more often treated with high-frequency ventilation).

CONCLUSIONS

The risk of death among neonates with hydrops fetalis depends on the underlying diagnosis and is highest for those who are born more prematurely and those who are most ill immediately after birth. Information from this large study should prove useful for planning prospective studies and providing prenatal counseling to parents with an affected fetus.