Mirror Syndrome During Pregnancy – Causes, Symptoms, and Treatment

Pregnancy is a beautiful yet crucial time for would-be parents. With the joy of new arrival in their family comes the responsibility of having a complication-free pregnancy. Some symptoms such as nausea, swelling, or high blood pressure are somewhat common complaints during pregnancy. These maladies though common, can be vexing for the pregnant woman. In some cases, these illnesses can be indicators of a serious complication for the mother or the baby. One such rare complication occurring during pregnancy is mirror syndrome. 

What Is Mirror Syndrome? 

Mirror syndrome, also called Ballantyne syndrome, is a rare complication occurring during pregnancy. The Mirror syndrome in pregnancy is a combination of two conditions – preeclampsia and hydrops. Preeclampsia is a form of high blood pressure or hypertension in pregnant women. Hydrops is edema or abnormal fluid accumulation in two or more body cavities such as the heart, abdomen, lungs, or skin.

It is also known as fetal mirror syndrome when referring to the fetus or maternal mirror syndrome in the pregnant woman. Hydrops gets these names as both the mother and the fetus have similar symptoms, or the edema in the fetus is similar to the edema of the mother. In hydrops mirror syndrome, the fluid accumulation in the mother mirrors the fluid accumulation in the fetus.  

Sometimes there is fluid accumulation in the cavity and beneath the skin of both mother and fetus along with the placenta. In such cases of fluid retention in all three places, the mirror syndrome is called triple edema. It is a rare yet extremely serious condition that can be potentially life-threatening for the mother or fetus, or both.

Causes of Mirror Syndrome

As mirror syndrome is a rare condition, there is no concrete data on its exact cause. Some causes of mirror syndrome include immunological disorders, general obstetric disorders, infections, anemia, and malformations. However, mirror syndrome when pregnant is most commonly caused by fetal hydrops.

Fetal hydrops occurs when the fluid leaves the fetus’s bloodstream and gets accumulated in the cavities or beneath the skin tissues of the fetus. It can have various causes depending on the type of fetal hydrops, such as infection, heart problem, genetic syndromes, or metabolic disorders.

However, it mostly develops when there is a complication in the natural fluid regulation of the fetus. When the woman is pregnant with twins, fetal hydrops can be caused by twin-to-twin transfusion syndrome.

Symptoms of Mirror Syndrome 

Early detection of any illness is always beneficial for timely treatment as it curtails the escalation of the illness before it reaches a severe level. Prompt action for any atypical condition during pregnancy is important as it makes all the difference in diagnosis and treatment.

Early detection is especially critical for mirror syndrome as it can be potentially life-threatening. So recognizing the symptoms and informing the healthcare professional is the first step towards appropriate diagnosis and timely treatment. Some of the common symptoms of mirror syndrome are: 

• Severe swelling
• Water retention
• Nausea or vomiting 
• Excessive weight gain by the pregnant woman in a short time
• Hypertension or high blood pressure
• Presence of protein in the urine
• Hemodilution – The condition where there is a higher amount of plasma in the blood with a low amount of red blood cells. It generally occurs due to an increase in fluid and is detected through a blood test.

Complications of Mirror Syndrome 

Mirror syndrome is a serious complication during pregnancy and can be dangerous for the mother and the fetus. Preeclampsia is experienced by the pregnant woman and affects the fluids in the lungs as a complication of mirror syndrome. The pregnant woman may experience a ruptured or obstructed bladder, resulting in the death of the fetus. In extreme cases, an emergency cesarean is warranted to save the fetus.

How Is Mirror Syndrome Diagnosed? 

Accurate diagnosis of mirror syndrome is the key to decreasing the risks for the mother and the fetus. However, there is no specific test to diagnose it. Still, results from other tests help in forming an appropriate diagnosis for mirror syndrome. Ultrasounds help in detecting excess fluid accumulation in the fetus or the placenta.

Tests can help detect the presence of protein in the urine, high blood pressure, and other abnormalities in the pregnant woman. Tests of both the pregnant woman and the fetus, self-reported symptoms, and other signs observed by the doctor are valuable tools in diagnosing mirror syndrome.

How Is Mirror Syndrome Treated?

As mirror syndrome is a rare disorder, its treatment varies depending on the specific condition. Treatment majorly depends on the severity of preeclampsia and the main cause of fetal hydrops. If the health care professional can treat the diagnosed cause of fetal hydrops, the symptoms of mirror syndrome can be alleviated for both mother and baby.

As the baby is treated for the cause of hydrops in the womb, the mirror syndrome symptoms for the mother may clear up too, resulting in normal pregnancy and delivery. In cases where preeclampsia is serious, emergency delivery may be advised. This relieves the maternal mirror symptoms in a few days for the mother. Once the baby is delivered, NICU (Newborn Intensive care Unit) staff will provide the appropriate treatment to treat hydrops and their underlying cause. 

If the doctor can diagnose the exact cause of fetal hydrops, they can administer the treatment on the fetus depending on the cause. The fetal hydrops treatment may include medications for cardiac arrhythmia, transfusions to correct anemia, reduction of lesions to impede lymphatic return or cardiac venous return, or procedures that stop blood loss. Fetal surgery in cases of mirror syndrome is highly risky, therefore, rarely advised. Emergency delivery is the best option, in such cases depending on the gestation period. However, at times it may not be the immediate solution. 

In some cases, the mother too is administered medications for the treatment of mirror syndrome. Most of the time, the mother could be advised strict bed rest to reduce edema and hypertension. As each case of mirror syndrome is unique and different; hence, a different treatment plan is recommended for each instance. However, the best course of treatment for mirror syndrome is early detection to control the edema before it incurs too much damage. 

In many cases, the underlying cause of fetal hydrops cannot be diagnosed. Treatment of mirror syndrome becomes difficult without knowing the exact cause. Treatment may be harmful and dangerous without knowing the pathophysiology cause of fetal hydrops. Therefore to arrive at the accurate pathophysiology cause, doctors do various tests such as ultrasound and tests on the mother to confirm mirror syndrome for the best course of treatment.

Mirror syndrome is a rare and potentially threatening condition for both mother and baby. However, it is treatable, especially when detected early. At times the pregnant woman may feel she is overreacting to every change or discomfort. But it is important to inform the healthcare provider about every symptom for the proper diagnosis and treatment of mirror syndrome.

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