Maternal mirror syndrome with fetal hydrops due to parvovirus infection

Abstract

Mirror syndrome, also referred to as Ballantyne’s syndrome, pseudotoxemia, or triple edema, is a rare clinical condition whose pathophysiology remains incompletely understood. This syndrome, associated with the development of fetal hydrops, consistently involves maternal edema and is most commonly observed in cases of severe fetal hydrops, regardless of its origin. We present a clinical case in which Mirror syndrome developed due to parvovirus infection and fetal hydrops. A patient, at 18 weeks of gestation, developed a parvovirus infection and underwent home-based treatment. At 22 weeks and 4 days of gestation, the patient presented to the hospital with fetal hydrops and severe anaemia, and a single episode of elevated blood pressure (190/122 mmHg). At 22 w. and 6 d. due to severe fetal anaemia and fetal hydrops, cordocentesis and intrauterine blood transfusion were performed. Fetalanemia necessitated a repeat cordocentesis and erythrocyte transfusion at 24 w. and 0 d. (fetal anaemia decreased, but there were signs of placentomegaly and polyhydramnios). The patient’s condition had worsened, with signs of edema, proteinuria, HELLP syndrome and a diagnosis of placenta previa, prompting a category II emergency cesarean section. At 24 w. and 5 d. 578 g newborn Apgar 4-5-7 was born, transported to NICU and at the moment is 3 month of age. This case highlights the importance of recognizing and managing Mirror syndrome, particularly when it mimics conditions such as pre-eclampsia and HELLP syndrome, to mitigate risks of severe maternal and perinatal complications.