Agustín-Oliva A, Serrano-Viñuales I, de Bonrostro-Torralba C, Herrero-Serrano R, Garrido-Fernández P, Campillos-Maza JM

Language: Spanish
References: 24
Page: 832-841
PDF size: 444.48 Kb.

ABSTRACT

Background: Ballantyne syndrome is characterized by the triad: fetal, placental and maternal edema. It is an uncommon condition associated with fetal hydrops, in which mother reflects fetal symptoms. It is essential to differentiate from preeclampsia, since there are common signs such as hypertension and proteinuria. Etiopathogenesis is unknown, although theories associated with an imbalance between angiogenic and antiangiogenic factors have been postulated. Treatment consists of ending the pregnancy or improving the fetal situation.
Clinical case: We present the case of a 29-years pregnant woman controlled in the Maternal-Fetal Medicine Unit due to the history of Ballantyne Syndrome in the previous gestation. In the follow-up ultrasound performed at 26-weeks, placentomegaly, fetal ascites and increased amniotic fluid were detected. Subsequent ultrasounds showed polyhydramnios and fetal hydrops at 28-weeks. After maternal edema began, she was diagnosed with recurrent Mirror Syndrome and non-immune hydrops. Admission was indicated and amniodrainage was performed due to symptomatic polyhydramnios. Finally, premature rupture of membranes occurred at 29+6-weeks. She started uterine dynamic after one week, ending in a preterm delivery at 31-weeks after premature rupture of membranes. A 3200gr male was born with Apgar Scores 2-6-8 at 1, 5 and 10min respectively and, after postnatal study, he was diagnosed with multiple ileal perforation. Five surgical interventions were necessary, with a complicated postoperative period and could be discharged at 3 months of age.
Conclusions: Mirror syndrome is an underdiagnosed pathology of unknown incidence that can seriously complicate gestation associated with fetal hydrops. Maternal recovery is favorable few days after delivery, but it leads to high fetal morbi-mortality.

REFERENCES

1. van Selm M, Kanhai H, Bennebroek Gravenhorst J. Maternal hydrops syndrome: a review. Obstetrical and Gynecological Survey. 1991; 46(12): 785-88.

2. Torres-Gómez LG, Silva-González ME, González-Hernández R. Síndrome de Ballantyne o síndrome en espejo. Ginecol Obstet Mex. 2010; 78 (11): 621-25.

3. Braun T, et al. Mirror syndrome: a systematic review of fetal assocaited conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther. 2010; 27: 191-203.

4. Zhao Y, Liu G, Wang J, Yang J, Shen D, Zhang X. Mirror syndrome in a chinese hospital: diverse causes and maternal fetal features. The Journal of Maternal-Fetal and Neonatal Medicine. 2013; 26 (3): 254-58.

5. Hirata G, et al. Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases. J Matern Fetal Neonatal Med. 2016; 29 (16): 2630-34.

6. Saviron Cornudella R, et al. Síndrome de Ballantyne (síndrome del espejo o mirror syndrome). Rev Chil Obstet Ginecol. 2013; 78 (3): 224-28.

7. Allarakia S, et al. Characteristics and management of mirror syndrome: a systematic review (1956-2016). J Perinat Med. 2017; 45 (9): 1013-21.

8. Yeon Lee J, Yun Hwang J. Mirror syndrome associated with fetal leukemia. Journal of Obstetrics and Gynaecology Research. 2014.

9. García Rodríguez R, et al. Síndrome del espejo asociado a infección por parvovirus B19: la madre refleja lo que le ocurre al feto. Prog Obstet Ginecol. 2016; 59 (3): 160-65.

10. Iciek R, et al. Ballantyne syndrome (mirror syndrome) associated with severe non-immune fetal hidrops- a case report. Ginekol Pol. 2015; 86: 706-11.

11. Corbillon L, et al. Clinical Biological Features of Ballantyne Syndrome and the Role of Placental Hydrops. Obstetrical & Gynecological Survey. 1997; 52 (5): 310-14.

12. Espinoza J, et al. A role of the anti-angiogenic factor sVEGFR- 1 in the "mirro syndrome" (Ballantyne´s syndrome). J Matern Neonatal Med. 2006; 19: 607-13.

13. Suzuki Y, et al. Echocardiography findings in a case with Ballantyne syndrome. J Obstet Gynaecol. 2017; 43 (2): 387-91.

14. Banoth P, Chaudhary K. Proteinuria: a presenting manifestation of mirror syndrome in pregnancy. Clin Nephrol. 2018; 90 (1): 60-63.

15. Bixel K, et al. Placental origins of angiogenic dysfunction in mirror syndrome. Hypertension in Pregnancy. 2012; 31: 21117.

16. Jeffcoate TN, Scott JS. Some observations on the placental factor in pregnancy toxemia. AJOG. 1959; 77(3): 475-89.

17. Takahashi H, et al. Maternal manifestation of Ballantyne´s syndrome occurring concomitantly with deveolpment of fetal congenital mesoblastic nephroma. J Obstet Gynaecol. 2014; 40 (4): 1114-17.

18. LLurba E, et al. Angiogenic and antiangiogenic factors before and afeter resolution of maternal mirror syndrome. Ultrasound Obstet Gynecol. 2012; 40 (3): 367-9.

19. Katoh Y, et al. Elevation of maternal serum sFlt-1 in pregnancy with mirror syndrome caused by fetal cardiac failure. Oxf Med Case Reports. 2018; 3: 111-14.

20. Chimenea A, et al. Resolution of maternal mirror syndrome after succesful fetal intrauterine therapy: a case series. BMC Pregnancy Childbirth. 2018;18-85.

21. Wu D, et al. Hydrops and preeclampsia: another look into mirror syndrome. Am J Obstet Gynecol. 2008; 199 (6): 194.

22. Midgley DY, Harding K. The Mirror Syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000; 88: 201-2.

23. Tayler E, DeSimone C. Anesthetic management of maternal Mirror syndrome. International Journal of Obstetric Anesthesia. 2014; 386-89.

24. Saleh N, et al. Prenatal diagnosis and postnatal management of meconium peritonitis. J Perinat Med. 2009; 37: 535-38.