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Gavin NR, Forrest AD, Rosner M, Miller JL, Baschat AA. The role of fetal therapy in the management of mirror syndrome: a narrative review. J Matern Fetal Neonatal Med 2024; 37:2345307. [PMID: 38679585 DOI: 10.1080/14767058.2024.2345307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Mirror syndrome (MS) is a condition characterized by the presence of maternal, fetal, and placental edema and is reversible through delivery or pregnancy termination. As fetal hydrops itself may be amenable to treatment, we sought to determine outcomes for MS primarily managed by fetal therapy through a narrative review of the literature and cases managed at our fetal center. STUDY DESIGN PubMed, Embase, Web of Science, Scopus, and Google Scholar databases were searched through January 2024 using key words: mirror syndrome, Ballantyne's syndrome, fetal hydrops, maternal hydrops, pseudotoxemia, triple edema, maternal recovery, fetal therapy, and resolution. Manuscripts describing primary management by fetal therapy that included maternal and fetal outcomes were identified. Clinical details of MS patients managed with fetal therapy at our center were also included for descriptive analysis. RESULTS 16 of 517 manuscripts (3.1%) described fetal therapy as the primary intended treatment in 17 patients. 3 patients managed at our center were included in the analysis. Among 20 patients undergoing primary fetal therapy for management of mirror syndrome, median gestational age of presentation was 24 weeks and 5 days gestation; predominant clinical findings were maternal edema (15/20), proteinuria (10/20), pulmonary edema (8/20), and hypertension (8/20); the primary laboratory abnormalities were anemia (8/20) and elevated creatinine or transaminases (5/20). Condition-specific fetal therapies led to resolution of hydrops in 17 (85%) cases and MS in 19 (95%) cases. The median time to hydrops resolution was 7.5 days and to resolution of mirror syndrome was 10 days. Fetal therapy prolonged pregnancy by a median of 10 weeks with a median gestational age of 35 weeks and 5 days at delivery. All women delivered for indications other than mirror syndrome and 19/20 fetuses survived. CONCLUSION In appropriately selected cases, MS often resolves after fetal therapy of hydrops allowing for safe pregnancy prolongation with good maternal and infant outcomes.
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Affiliation(s)
- Nicole R Gavin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Connecticut School of Medicine, Storrs, CT, USA
| | - Alexandra D Forrest
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mara Rosner
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA
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Štritof PG, Zanze L, Zekan P, Horvat G, Blagaic V. Mirror syndrome associated with fetal cardiomyopathy. Arch Clin Cases 2023; 10:191-195. [PMID: 38098693 PMCID: PMC10719984 DOI: 10.22551/2023.41.1004.10273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Mirror syndrome is a rare condition of generalized maternal oedema caused by fetal hydrops. A 37-year-old patient was admitted to our hospital because of suspected mirror syndrome caused by fetal cardiomyopathy. At 26th week of gestation patient developed bilateral pulmonary oedema as her condition rapidly deteriorated. Consequently, preterm labor was induced, percutaneous evacuation of fetal ascites was performed, and the patient finally vaginally delivered stillborn fetus. Although the initial postpartum period was severely complicated by hemorrhage, the condition of the patient significantly improved later, and she was discharged seven days after delivery. We believe this case is worth presenting due to its rarity and significant perinatal and obstetric challenges in treatment of those patients. Furthermore, preimplantation genetic testing could be performed to prevent at least some of the cases.
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Affiliation(s)
- Petra Glad Štritof
- Department of Obstetrics and Gynecology, University Hospital “Sveti Duh“, Zagreb, Croatia
| | - Lucija Zanze
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Paulo Zekan
- Department of Obstetrics and Gynecology, University Hospital “Sveti Duh“, Zagreb, Croatia
| | | | - Vladimir Blagaic
- Department of Obstetrics and Gynecology, University Hospital “Sveti Duh“, Zagreb, Croatia
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Bedei IA, Graf A, Gloning KP, Meyer-Wittkopf M, Willner D, Krapp M, Hentze S, Scharf A, Degenhardt J, Heling KS, Kozlowski P, Trautmann K, Jahns K, Geipel A, Tekesin I, Elsässer M, Wilhelm L, Gottschalk I, Baumüller JE, Birdir C, Zöllner F, Wolter A, Schenk J, Gehrke T, Keil C, Espinosa J, Axt-Fliedner R. Is Fetal Hydrops in Turner Syndrome a Risk Factor for the Development of Maternal Mirror Syndrome? J Clin Med 2022; 11:4588. [PMID: 35956203 DOI: 10.3390/jcm11154588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
Mirror syndrome is a rare and serious maternal condition associated with immune and non-immune fetal hydrops after 16 weeks of gestational age. Subjacent conditions associated with fetal hydrops may carry different risks for Mirror syndrome. Fetuses with Turner syndrome are frequently found to be hydropic on ultrasound. We designed a retrospective multicenter study to evaluate the risk for Mirror syndrome among pregnancies complicated with Turner syndrome and fetal hydrops. Data were extracted from a questionnaire sent to specialists in maternal fetal medicine in Germany. Out of 758 cases, 138 fulfilled our inclusion criteria and were included in the analysis. Of the included 138, 66 presented with persisting hydrops at or after 16 weeks. The frequency of placental hydrops/placentomegaly was rather low (8.1%). Of note, no Mirror syndrome was observed in our study cohort. We propose that the risk of this pregnancy complication varies according to the subjacent cause of fetal hydrops. In Turner syndrome, the risk for Mirror syndrome is lower than that reported in the literature. Our observations are relevant for clinical management and parental counseling.
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Song S, Zhu Y, Jorch G, Zhang X, Wu Y, Chen W, Gong H, Zhou L, Wang X, Zhong X. A very preterm infant born to mother of mirror syndrome secondary to fetomaternal hemorrhage: a case report. BMC Pregnancy Childbirth 2021; 21:701. [PMID: 34663239 PMCID: PMC8522257 DOI: 10.1186/s12884-021-04179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mirror syndrome (MS) is defined as maternal edema with fetal hydrops and placental edema with different etiologies, such as rhesus isoimmunization and twin-twin transfusion syndrome. Herein, we showcased a unique MS case secondary to fetomaternal hemorrhage (FMH). Case presentation A 32-year-old gravida 2 para 0 woman diagnosed with fetal hydrops was admitted to our hospital. Maternal laboratory tests revealed anemia, slightly increased creatinine and uric acid levels, hypoproteinemia, and significantly increased alpha-fetoprotein and hemoglobin-F levels. Therefore, FMH was diagnosed initially. Two days after admission, the woman had unexpectedly progressive anasarca and started to feel chest distress, palpitations, lethargy, and oliguria, and MS was suspected. An emergency cesarean section was performed to terminate the pregnancy. The maternal clinical symptoms and laboratory tests rapidly improved after delivery. A very preterm infant with a 2080-g birthweight at 31 weeks gestation survived after emergency cesarean section, active resuscitation, emergency blood transfusion, abdominocentesis, and advanced life support. Conclusions FMH could develop into MS, providing new insights into the etiology of MS. Once MS is diagnosed, emergency cesarean section might be an alternative treatment. The very preterm infant survived with a favorable long-term outcome, and a well-trained perinatal work team is needed for such cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04179-5.
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Affiliation(s)
- Sijie Song
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Yefang Zhu
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Gerhard Jorch
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China.,Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Xiaoting Zhang
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Yan Wu
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Wen Chen
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Hua Gong
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Ligang Zhou
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Xueyan Wang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoyun Zhong
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China.
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Han Z, Chen X, Wang Q, Zhou J, Guo Y, Hou H, Zhang Y. Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study. BMC Pregnancy Childbirth 2021; 21:660. [PMID: 34583666 PMCID: PMC8480018 DOI: 10.1186/s12884-021-04143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mirror syndrome (MS) is a rare obstetric disorder complicated with high maternal morbidity and fetal mortality. MS is often misdiagnosed or underdiagnosed due to the low incidence and lack of awareness of its diverse features. This study aimed to summarise the etiology, clinical characteristics, and risk factors of MS among mothers with fetal hydrops. METHODS This retrospective case-control study included 37 pregnant women with fetal hydrops in the second and third trimesters from 58,428 deliveries performed at the Third Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2020. Cases were categorized as MS and non-MS according to the presence or absence of maternal mirroring symptoms. Binary logistic regression was performed for analysis. RESULTS Fourteen women developed MS with an overall incidence of 0.024% (14/58,428) and 37.8% (14/37) in the fetal hydrops cases. Among the 11 MS cases with known associated etiologies, seven had alpha thalassemia major. Onset of fetal hydrops was later (27.8 vs. 23.0 weeks) and the rate of placental thickening was higher (85.7% vs. 34.8%) in the MS group than in the non-MS group (P < 0.05). Regarding maternal characteristics, the MS group had higher maternal morbidity (85.7% vs. 8.7%), more weight gain (9.0 vs. 5.5 kg), higher rates of hypertension (35.7 vs. 0%) and proteinuria (64.3% vs. 4.3%), and lower levels of hemoglobin (88 vs. 105 g/L) and serum albumin (25.8 vs. 35.0 g/L) than the non-MS group (P < 0.05). Logistic regression analysis showed that onset of fetal hydrops at ≥24 weeks and placental thickening were associated with the risk of MS among fetal hydrops cases (OR 15.83, 95% CI 1.56-160.10 and OR 8.63, 95% CI 1.29-57.72, respectively). CONCLUSIONS MS is relatively common among fetal hydrops cases in the late second and third trimesters, and alpha thalassemia major is the main etiology for fetal hydrops and also MS in this population. Complicated with high maternal morbidity, the key maternal features of MS include more weight gain, hemodilution, and hypertension. Among those with fetal hydrops, the onset time of ≥24 weeks and placental thickening are risk factors for MS.
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Affiliation(s)
- Zhenyan Han
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Xiaodan Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Qingqing Wang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Yan Guo
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Hongying Hou
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
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Mohamad Zon E, Nik Lah NAZ, Hoo PS. Late-Onset Mirror Syndrome. Malays Fam Physician 2021; 16:129-132. [PMID: 33948153 PMCID: PMC8088733 DOI: 10.51866/cr1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mirror syndrome is a rare clinical condition in pregnancy associated with significant fetal mortality and maternal morbidity. It is characterized by a triad of complications: fetal hydrops, placenta oedema, and maternal oedema. We are reporting one case of late-onset Mirror syndrome in which the patient presented later in the gestation of 36 weeks due to excessive weight gain and clinical sign mimicking preeclampsia. Awareness of this disease is essential, as a failure of recognition will delay the treatment and cause higher maternal and perinatal morbidity and mortality.
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Affiliation(s)
- Erinna Mohamad Zon
- MD (USM), MMed O&G (USM), Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia, Department of Obstetrics & Gynaecology, Hospital Universiti Sains Malaysia, Malaysia
| | - Nik Ahmad Zuky Nik Lah
- MD (USM), MMed O&G (USM), Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
| | - Pek Sung Hoo
- MD (UKM) MRCOG (UK), Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
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Teles Abrao Trad A, Czeresnia R, Elrefaei A, Ibirogba ER, Narang K, Ruano R. What do we know about the diagnosis and management of mirror syndrome? J Matern Fetal Neonatal Med 2021; 35:4022-4027. [PMID: 33722118 DOI: 10.1080/14767058.2020.1844656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mirror syndrome is a rare disease associated with high fetal mortality of up to 67.2%. It is thought to be underdiagnosed and is often associated with preeclampsia. Mirror syndrome is characterized by "triple edema": generalized maternal, placental, and fetal edema. OBJECTIVE This comprehensive review aims to thoroughly summarize the existing data and provide a broad update on the topic to help accurate diagnosis and encourage further research. METHODS A comprehensive search of several databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) was conducted. RESULTS The last systematic review of mirror syndrome cases was conducted in 2016 and included 113 patients. Much is still unknown about the pathophysiology of the disease and it remains underdiagnosed. CONCLUSIONS AND RELEVANCE Mirror syndrome is likely more prevalent than current data suggests for it is often misdiagnosed as pre-eclampsia. The differential of Mirror syndrome should be considered in anomalous presentations of pre-eclampsia as intervention may save the fetus and improve maternal symptoms. It is important to further the study on the pathophysiology of the disease to better understand, diagnose and potentially treat it, to avoid its high morbidity and mortality.
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Affiliation(s)
- Ayssa Teles Abrao Trad
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ricardo Czeresnia
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amro Elrefaei
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eniola R Ibirogba
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kavita Narang
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Tanaka K, Hosoi K, Yoshiike S, Nagahama K, Tanigaki S, Shibahara J, Ohnishi H, Kobayashi Y. Mirror syndrome due to anti-Jra alloimmunization. Taiwan J Obstet Gynecol 2020; 59:456-9. [PMID: 32416899 DOI: 10.1016/j.tjog.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We report a case of fetal hydrops and mirror syndrome in a pregnancy with anti-Jra alloimmunization. CASE REPORT A 34-year-old multiparous woman (G3P2) at 29 weeks of gestation had complications which included generalized edema and mild dyspnea. An indirect Coombs test was positive for anti-Jra antibodies. A blood examination showed hemodilution and elevated human chorionic gonadotropin. An ultrasound examination showed fetal hydrops with cardiomegaly and polyhydramnios. The patient delivered a pale and edematous infant by cesarean section and laboratory tests showed that the neonate had severe anemia (Hb 4.4 g/dL). A direct Coombs test was also positive. Microscopic examination of the placenta revealed diffuse villous edema. A genetic test for the ABCG2 gene showed the homozygous point mutation c.376C > T (376TT) in the mother, while her three offsprings all exhibited 376CT heterozygosity. CONCLUSION The potential risk of severe fetal hydrops and mirror syndrome should be recognized in pregnancies with anti-Jra alloimmunization.
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Mathias CR, Rizvi C. The diagnostic conundrum of maternal mirror syndrome progressing to pre-eclampsia - A case report. Case Rep Womens Health 2019; 23:e00122. [PMID: 31193796 PMCID: PMC6542765 DOI: 10.1016/j.crwh.2019.e00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Mirror syndrome, also called Ballantyne syndrome, is a rare condition in pregnancy, defined by the presence of the clinical triad of fetal hydrops, placentomegaly and maternal oedema. Any aetiology of fetal hydrops, including rhesus iso-immunization, congenital infection, twin-to-twin transfusion, structural anomalies and fetal malignancies, can lead to the syndrome. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also seen in pre-eclampsia, and, hence, the two conditions may have a similar clinical presentation. They may even co-exist, where a patient with maternal mirror syndrome develops features of pre-eclampsia. A timely, accurate diagnosis and prompt interventions are needed to prevent fetal mortality and maternal morbidity. Mirror syndrome is a rare condition in pregnancy defined by the clinical triad of fetal, placental and maternal hydrops The correction of fetal hydrops (and, hence placental hydrops) resolves Mirror syndrome The trophoblastic damage caused by placental oedema causes endothelial dysfunction leading to Mirror syndrome Although Mirror syndrome and pre-eclampsia have different aetiologies they may have similar presentations and co-exist
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Affiliation(s)
- Caroline Ruth Mathias
- Department of Obstetrics and Gynaecology, Nepean Hospital, Kingswood, 2747, NSW, Australia
| | - Carmela Rizvi
- Department of Obstetrics and Gynaecology, Nepean Hospital, Kingswood, 2747, NSW, Australia
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Baumgarten HD, Gebb JS, Khalek N, Moldenhauer JS, Johnson MP, Peranteau WH, Hedrick HL, Adzick NS, Flake AW. Preemptive Delivery and Immediate Resection for Fetuses with High-Risk Sacrococcygeal Teratomas. Fetal Diagn Ther 2018; 45:137-144. [PMID: 29734172 DOI: 10.1159/000487542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fetuses with "high-risk" sacrococcygeal teratoma (SCT) have a mortality rate of 40-50%. While fetal surgery may benefit select fetuses prior to 27 weeks' gestation, many fetuses die due to consequences of rapid tumor growth after 27 weeks. Here we report our experience applying "preemptive" delivery to fetuses who manifest signs of decompensation between 27 and 32 weeks. METHODS A retrospective review of SCT fetuses delivered between 2010 and 2016 at ≤32 weeks' gestation was performed. Patients who decompensated prior to 27 weeks and were treated with fetal surgery or neonatal palliation were excluded. RESULTS Forty-two SCT fetuses were evaluated, and 11 were preemptively delivered in response to impending fetal or maternal decompensation. Nine (81.8%) survived. One death was due to pulmonary hypoplasia in a neonate with significant intra-abdominal tumor burden, and the other was due to in utero tumor rupture. There were no deaths related to prematurity in this cohort. CONCLUSIONS Many fetuses with SCT manifest signs of decompensation between 27 and 32 weeks. In the absence of fetal hydrops prior to 27 weeks or tumor rupture in utero, early delivery is associated with favorable outcomes. Our single-center experience supports a management algorithm change to incorporate "preemptive" delivery for selected cases.
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Chimenea A, García-Díaz L, Calderón AM, Heras MMDL, Antiñolo G. Resolution of maternal Mirror syndrome after succesful fetal intrauterine therapy: a case series. BMC Pregnancy Childbirth 2018; 18:85. [PMID: 29625560 PMCID: PMC5889608 DOI: 10.1186/s12884-018-1718-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/26/2018] [Indexed: 11/26/2022] Open
Abstract
Background Mirror syndrome (MS) is a rare obstetric condition usually defined as the development of maternal edema in association with fetal hydrops. The pathogenesis of MS remains unclear and may be misdiagnosed as pre-eclampsia. Case presentation We report a case series of MS in which fetal therapy (intrauterine blood transfusion and pleuroamniotic shunt) resulted in fetal as well as maternal favourable course with complete resolution of the condition in both mother and fetus. Conclusions Our case series add new evidence to support that early diagnosis of MS followed by fetal therapy and clinical maternal support are critical for a good outcome.
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Affiliation(s)
- Angel Chimenea
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Lutgardo García-Díaz
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Ana María Calderón
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - María Moreno-De Las Heras
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Genetics, Reproduction, and Fetal Medicine, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain. .,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain.
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Li H, Gu WR. Mirror syndrome associated with heart failure in a pregnant woman: a case report. Int J Clin Exp Med 2015; 8:16132-16136. [PMID: 26629125 PMCID: PMC4659014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
Mirror syndrome is also known as Ballantyne syndrome, maternal hydrops, triple edema and pseudotoxemia. The disease can be difficult to diagnose, is related to pregnancy and can grievously endanger the health of both the mother and fetus. The pathogenesis of the disease has not been fully elucidated, and this disease may be confused with preeclampsia, even though distinguishing features can be identified. In this report case, we describe a pregnant woman who suffered from mirror syndrome associated with heart failure. After delivery, the heart failure symptoms also disappeared.
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Affiliation(s)
- Han Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China
| | - Wei-Rong Gu
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China
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