What Is Maternal Mirror Syndrome?
Mirror syndrome, also known as triple edema or Ballantyne syndrome, is a rare maternal complication associated with pregnancy. Mirror syndrome is characterized by two conditions: hydrops fetalis, and preeclampsia. When it occurs, it becomes potentially life-threatening. Considering the mother, it is referred to as maternal mirror syndrome, and considering the fetus, it is called fetal mirror syndrome. Fetal mirror syndrome may lead to malformations or anomalies in the fetus. In some cases, fluid accumulation occurs beneath the mother’s and fetus’s skin and the placenta. Due to the involvement of these three locations, it is also called triple edema.
What Causes Maternal Mirror Syndrome?
The condition's precise cause is still unknown, and studies are ongoing to confirm the causative factors. Some of the probable causes of maternal mirror syndrome include the following:
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Obstetric Disorders: Obstetric disorders include life-threatening conditions affecting pregnant women and their children.
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Immunological Disorders: Conditions or diseases caused due to impaired functioning of the immune system are called immunological disorders.
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Infections: Infections affecting the mother or the fetus can lead to maternal mirror syndrome.
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Anemia: When the number of red blood cells decreases, it leads to a condition called anemia. Pregnant women are at more risk of developing anemia. Anemia during pregnancy can be of four types: folate deficiency, iron deficiency, vitamin B12 deficiency, or anemia of pregnancy.
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Fetal Hydrops: Hydrops fetalis is the swelling or severe edema seen in two or more body parts of the fetus. Immune hydrops fetalis may be due to Rh incompatibility. Nonimmune hydrops fetalis is the most common type of fetal hydrops. It is a severe condition. Infections, metabolic conditions, and metabolic or cardiac disorders are the leading causes of the condition. Twin-to-twin transfusion may also lead to the conditions in the case of mothers pregnant with twins.
What Are the Symptoms of Maternal Mirror Syndrome?
Understanding the symptoms of maternal mirror syndrome is essential in the case of maternal mirror syndrome. Early detection helps manage the condition in a timely and prevents the illness from escalating to a severe life-threatening condition. Some of the symptoms of maternal mirror syndrome are the following:
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Water retention leads to severe swelling.
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The pregnant woman may gain a lot of body weight in a short period.
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The pregnant woman may experience increased blood pressure or hypertension.
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The mother may get nauseous and vomit seriously.
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The pregnant mother may develop a condition called proteinuria. Proteinuria is when the urine contains more amount of protein.
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Hemodilution is more likely to occur in the case of maternal mirror syndrome. Hemodilution is a condition where the concentration of cells and solids in the blood decreases. This increases the fluid portion of the blood. During pregnancy, physiological changes in the woman's body lead to an increased plasma (liquid part of the blood) volume, leading to hemodilution.
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Excess abdominal fluid or ascites can lead to maternal mirror syndrome. The pregnant woman's abdomen will appear more swollen than in a normal pregnancy, and pain may also be felt due to swelling.
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More volume of amniotic fluid surrounding the baby leads to polyhydramnios and can cause maternal mirror syndrome.
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High blood pressure during pregnancy may lead to a condition called preeclampsia. Proteinuria and hypertension are the characteristic symptoms of the condition. Preeclampsia leads to fatal complications for the baby and the mother. Preeclampsia leads to vasospasm (constriction or tightening of the artery) and endothelial dysfunction (constriction or narrowing of the lumen of the large blood vessels on the surface of the heart).
Why Is Maternal Mirror Syndrome Considered Life-Threatening?
Maternal mirror syndrome can be fatal and can lead to the following complications:
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Pulmonary Edema: The accumulation of fluid within the lungs is called pulmonary edema. Severe preeclampsia during pregnancy can lead to acute pulmonary edema. It may be characterized by swelling of the extremities, face, or under the eyes. The mother may suffer from severe shortness of breath and find it difficult to lie down, change posture, or do routine work.
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Acute Respiratory Distress Syndrome: ARDS or acute respiratory distress syndrome is when fluid builds up in the air sacs of the lungs. Maternal mirror syndrome can lead to acute respiratory distress syndrome in the woman. Maternal ARDS can lead to spontaneous preterm birth (delivering the baby before the 37th week of pregnancy), cardiac problems in the fetus, and neonatal death.
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Pericardial Effusion: Fluid buildup in the space around the heart leads to a condition called pericardial effusion. Excess fluid accumulation applies more pressure on the heart, impairing the pumping function.
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Renal Failure: Kidney or renal failure is when the kidneys cannot remove waste from the body.
How to Diagnose Maternal Mirror Syndrome?
Maternal mirror syndrome cannot be exclusively diagnosed, but the related symptoms can be observed and diagnosed to confirm the condition. An ultrasound scanning helps see the increased fluid accumulation. The blood pressure readings during routine checkups will help the doctor determine whether the mother has preeclampsia. Urine tests help diagnose proteinuria. The doctor may also observe other symptoms developed in the mother to diagnose maternal mirror syndrome.
How to Treat Maternal Mirror Syndrome?
The treatment of maternal mirror syndrome depends on the cause and symptoms. The exact cause for preeclampsia and fetal hydrops will be assessed, and the required treatment will be provided. These conditions can be due to known or unknown reasons. Progress in the symptoms of the mother or the fetus helps determine whether the treatment is beneficial for that particular patient.
In some cases, the delivery will be indicated, and the maternal symptoms will be treated for relief after delivery. In such cases, the newborn will be admitted to a NICU or neonatal intensive care unit for providing extra care and treatment.
Conclusion
Maternal mirror syndrome is a rare pregnancy complication. The symptoms of the condition may be felt as regular pregnancy changes. In case of severe swelling and pain, the expecting woman should speak about the same with their doctor. Regular checkups and prenatal care are essential during pregnancy to rule out the possibility of such medical conditions.
