Mirror syndrome is a medical condition that can manifest during pregnancy. The cardinal symptoms are edema, fetal hydrops, and hypertension in the mother. Various underlying diseases can be considered as the cause, on which the therapy of the syndrome depends.
What is mirror syndrome?
Mirror syndrome is a set of symptoms that can occur in women during pregnancy. The core symptoms are water retention in the mother’s body (edema) and in the fetus‘ body (hydrops). The condition is very rare: The medical literature describes well under 100 cases. However, researchers believe that practicing physicians often do not diagnose mirror syndrome as such. Since water retention in the legs – especially in the calves and feet – is very common in women during pregnancy, it does not usually arouse suspicion. Moreover, the clinical picture closely resembles the appearance of similar syndromes. Mirror syndrome comes from the English word for “mirror.” The clinical picture owes its name to the fact that maternal edema and fetal hydrops mirror each other. The Scottish physician John Williams Ballantyne was the first to describe the clinical picture. Occasionally, therefore, the term Ballantyne syndrome appears in the medical literature.
Causes
Several conditions are possible causes of mirror syndrome. The exact mechanisms that lead to the development of the clinical picture still require further research. One potential cause of mirror syndrome is rhesus incompatibility. The Rhesus factor is a property of the blood. In Rhesus-positive individuals, the red blood cells have the Rhesus factor antigen. When Rhesus-positive and Rhesus-negative blood mix, an immune reaction occurs and the body mistakenly breaks down the red blood cells. Normally, the bloodstream of the mother and the unborn child are separated by the placental barrier; red blood cells are too large to cross this barrier. Minimal injury, infection, and other circumstances, however, can increase the permeability of the placental barrier so that maternal and fetal blood come into direct contact. In this way, rhesus incompatibility leads to hemolytic (blood-dissolving) anemia. Mirror syndrome is merely a symptomatic consequence. Another possible cause of mirror syndrome is viral infections and malformations. They can cause the organism to retain water or be unable to pump invading fluid out of the tissues. In addition, fetofetal transfusion syndrome may be an underlying condition in mirror syndrome. This is a disorder of blood flow and nutrition that can occur in identical twins. It usually causes one of the twins to develop worse.
Symptoms, complaints and signs
Mirror syndrome is characterized by the simultaneous occurrence of water retention in the mother and the fetus. The mother’s edema can vary in severity – as can the hydrops of the fetus. No specific threshold exists. Pregnant women with mirror syndrome also have increased blood pressure (hypertension). This may manifest as headaches, dizziness, nausea, nosebleeds, and sleep disturbances. Particularly severe cases may also experience visual disturbances, severe thirst, and difficulty breathing. In many cases, however, high blood pressure progresses without any noticeable symptoms. Many of these symptoms also appear independently during pregnancy, which makes the diagnosis of mirror syndrome more difficult. Another sign of the clinical picture is the excessive excretion of proteins through the urine (proteinuria). Around 20 percent of all women suffer from proteinuria during pregnancy; mirror syndrome, on the other hand, is much rarer. Therefore, the occurrence of a single symptom does not necessarily mean that mirror syndrome is present.
Diagnosis and course of the disease
Physicians diagnose mirror syndrome by demonstrating the presence of each symptom in careful examinations. At a minimum, an ultrasound examination is required to identify fetal hydrops. The swollen tissue is often visible on the ultrasound image. For the diagnosis of proteinuria, pregnant women collect their urine over 24 hours.The laboratory can then determine the amount of protein in the collected urine. Normal is 50-150 mg. Differentially, doctors must rule out preeclampsia. Pregnancy toxicity can cause symptoms similar to mirror syndrome. Furthermore, physicians must rule out confusion with HELLP syndrome. Correct diagnosis is a prerequisite for effective treatment.
Complications
Mirror syndrome is itself a complication of pregnancy. It occurs very rarely and usually can be treated only by termination of pregnancy. In this case, the life of the child very often cannot be saved. The mother’s symptoms improve only if the causes of dropsy and polyhydramnios can be eliminated. The prognosis for the child depends on the gestational age and the underlying disease. Premature death of the unborn child is also possible. The risks for further severe complications increase with the duration of pregnancy. Therefore, it is necessary for the life of the mother and, in some cases, the child to initiate termination of pregnancy or premature birth immediately. In surviving children, late complications occur less frequently today than in the past because of good medical care. However, the trigger may be a hereditary malformation. In these cases, the surviving child always suffers from a disability. Rare complications in the mother include severe drop in hemoglobin, circulatory collapse, and heart failure. These complaints are often concomitant with embryonic death. Due to right heart failure, pulmonary edema and pleural effusions may also occur and may be fatal. Because of the various causes and the rarity of mirror syndrome, no universal statement can be made about the prognosis of this complication.
When should you see a doctor?
As a rule, when mirror syndrome appears, the expectant mother must definitely see a doctor and receive treatment. Unfortunately, in most cases, the treatment ends up terminating the pregnancy, so the child cannot be saved. In many cases the unborn child dies very early. If the pregnancy has already progressed, the doctor must induce a premature birth in the case of mirror syndrome. This saves the life of the mother and the life of the child. Since very serious complications can occur in mirror syndrome, urgent treatment is necessary. The mother should see the doctor when the symptoms of mirror syndrome appear during pregnancy. These include, for example, severe headaches, dizziness and nosebleeds. Visual disturbances and sleep disturbances may also occur. Most importantly, mirror syndrome is noticeable by severe thirst and problems with breathing. If these symptoms occur during pregnancy, a doctor must be consulted in any case.
Treatment and therapy
Treatment of mirror syndrome depends on the underlying disease. Blood transfusion may be required to treat rhesus incompatibility. In this case, the pregnant woman receives blood that comes from a donor. The blood transfusion can, to a limited extent, replace the red blood cells that the body mistakenly broke down in hemolysis. After birth, the child often requires intensive medical care. Because fluid may also have accumulated in the lungs, breathing may need to be artificially supported. Water may also accumulate in the cavities of the heart. Puncture of the affected tissue and other possible measures will help remove the excess fluid. The newborn may also need to receive a blood transfusion. Depending on the health of the mother and baby, it may be advisable for mirror syndrome to be delivered as early as possible. Normally, an early birth is associated with higher risks: However, in mirror syndrome, the risks of premature birth may be lower than the risks associated with a normal-length pregnancy in this condition. Doctors and parents must weigh what is best for mother and baby on a case-by-case basis.
Outlook and prognosis
As a complication of pregnancy, mirror syndrome is extremely concerning. Fortunately, it occurs very rarely, because even today it can often be treated only by terminating the pregnancy.Unfortunately, the life of the child can usually not be saved, and the mother’s complaints will only disappear if the triggers of polyhydramnios and dropsy can be eliminated. The prognosis for the unborn child depends on the month of pregnancy and the triggering pathology. In most cases the baby dies prematurely, because the longer the risk pregnancy lasts, the more severe the complications become. Therefore, it is imperative for the life of mother and baby to opt for termination of pregnancy or premature birth. If the baby survives this step, the prospects are relatively good nowadays thanks to improved medical care, as late complications occur less frequently. If a hereditary disease is the cause of mirror syndrome, the newborn is very likely to be disabled. However, mirror syndrome does not only have dire consequences for the baby; the mother also suffers complications such as a sharp drop in her hemoglobin level, a circulatory collapse or heart failure. These symptoms are often associated with the immediate loss of the embryo. If right heart failure is also present, the pregnant woman may experience pleural effusions or pulmonary edema, both of which can be fatal. However, from a medical point of view, because of the different triggers and the small number of known cases, no authoritative statement can be made about the prognosis of mirror syndrome without examining the affected woman.
Prevention
Because mirror syndrome is not a disease in its own right but a consequence of various causes, general prevention is not possible. Complications resulting from rhesus incompatibility can often be controlled by medication before mirror syndrome develops.
Follow-up
Because treatment of mirror syndrome is relatively complex and lengthy, follow-up care focuses on safe management of the condition. Affected individuals should try to build a positive attitude despite the adversity. In doing so, relaxation exercises and meditation can help calm and focus the mind. Various complications and complaints occur with mirror syndrome, which can always have a very negative impact on the life and quality of life of the affected person. The sleep complaints that occur can cause the patient to become irritable. Not infrequently, mirror syndrome is also associated with psychological upsets or even depression. This should be clarified with a psychologist. Sometimes an accompanying therapy can help to better accept the difficult situation.
What you can do yourself
Since there is no causal therapy, women with the disease should focus on their psychological condition. Due to the specific consequences of mirror syndrome, it can lead to the death of the fetus, thus also to stillbirths. This circumstance is difficult for expectant parents to cope with. Therefore, it may be advisable to seek help from counseling centers. If difficulties arise within a relationship, couples therapy may also be advisable. After all, it is precisely the cohesion of the partnership that is of considerable importance. In addition, the women concerned should pay more attention to the basic rules of behavior during pregnancy. Especially towards the end of pregnancy, sudden movements should be avoided. It is also helpful to lead a healthy lifestyle. It is true that this does not lead to a causal reduction in the risk of complications. However, a healthy lifestyle leads to a noticeable strengthening of the body, which improves wound healing capabilities and physical resistance.
