Clinical Data
A systematic review by Allarakia et al.4 included 113
patients with Mirror Syndrome diagnosed between 1956 and 2016. They
found that gestational age at presentation varied between 16 to 39 weeks
with a mean of 27 weeks. In 46.0% of cases maternal and fetal findings
were diagnosed simultaneously, in 41.0% fetal findings preceded any
maternal alterations and in the remaining 13.0% maternal findings were
first to appear. Most common maternal manifestation was weight gain or
edema, present in 84.0% of cases, followed by hypertension in 60.1%
and anemia or low hematocrit in 51.3%. The majority of fetuses
presented with hydrops fetalis (94.7%) or placental edema (62.8%).
Associated conditions were deemed to not influence overall fetal
mortality, they were: fetal anemia (16.8%), Rh-isoimmunization
(16.8%), multiple gestation pregnancy (16.8%), twin-to-twin
transfusion (13.2%), viral infections (15.9%) and one case of
metabolic disorder. Data analysis showed that procedural interventions
to correct fetal hydrops (maternal blood transfusion, intrauterine
transfusion, amniocentesis, laser ablation therapy, peritoneal-amniotic
shunt, thoracoamniotic shunt and aortic valve dilation) were
significantly associated with fetal survival, regardless the etiology of
the disease; the only other intervention to improve survival was
induction of labor. The overall survival rate of fetuses was 32.7% and
no maternal mortality was reported. Maternal symptoms were found to be
resolved in a median of 5.5 days after delivery; in 8 cases there was
complete reversal of maternal symptoms before delivery, following
supportive treatment or blood transfusion.