Mirror syndrome - case report and review of the literature

L. Pleș, D. Diaconescu, R.M. Sima, A.D. Stănescu

Rezumat: Introduction. Mirror syndrome (Ballantynes syndrome) refers to the presence of maternal edema (including anasarca and polyserosities) that mirrors the presence of fetal and placental hydrops. It is usually associated with nonimmune fetal hydrops, but it is also described in the immune-mediated response. The pathogenesis is unknown. One hypothesis is that the hydrophobic placenta causes systemic inflammatory response as a result of the release of placental molecules into the maternal circulation. Case presentation. We present the case of patient B.C., 22-yearsold, who came at the emergency room of Bucur Maternity for systematized uterine contractions. The admission diagnosis was IIP pregnancy without any type of prenatal care. The maternal clinical examination revealed lower limps edema. At 30 minutes from admission the patient spontaneously delivered a female fetus, 3710 g and 1 Apgar score. The clinical examination of the fetus revealed the presence of generalized fetal edema. The evolution of the fetus was unfavorable, with exitus at 45 minutes postpartum. The anatomo-pathological evaluation confirmed the presence of fetal polyserosity. The maternal evolution was slowly favorable, with the HELLP syndrome that required intensive care. Anti-D antibody titer at 12 hours postpartum was D 1/2156. The patient was discharged 10 days after the admission. Conclusions. The peculiarity of this case is a pregnancy without prenatal care, complicated with HELLP syndrome, with the delivery of a fetus with generalized edema, in the context of immune-mediated Mirror syndrome.
Cuvinte cheie: hydrops, sidrom HELLP, anti-D antibodies.