Research status of mirror syndrome

doi:10.3877/cma.j.issn.1673-5250.2021.03.006

Mirror syndrome is normally defined as development of maternal edema in association with hydrops fetalis (HF) and placenta hydrops. The incidence rate of mirror syndrome is rare and estimated to be 1/(5 800-10 000). It is known that a variety of etiologies including alloimmune response and non-immune factors may cause HF and then lead to mirror syndrome, but the specific pathophysiological mechanism is still unclear. The diagnosis of mirror syndrome is not difficult when finding HF and maternal hydrops at the same time. The etiological diagnosis of HF and mirror syndrome is also very important for clinical treatment, prognosis and recurrence risk assessment. In general, the prognosis of mirror syndrome is poor with very high fetal and neonatal mortality. The treatment mainly depends on the cause of HF. If there are no effective measures to alleviate HF, it is recommended to terminate pregnancy as soon as possible.

Key words: Mirror syndrome, Hydrops fetalis, Immune hydrops fetalis, Non-immune hydrops fetalis, Pre-eclampsia, Ultrasonography, prenatal

表1 NIHF的病因与HF发生率及其发生机制

NIHF病因	HF发生率	HF发生机制
心血管功能异常	17%～35%	中心静脉压升高
染色体异常	7%～16%	心脏结构或功能异常，淋巴发育不良，骨髓细胞异常生成
血液系统异常	4%～12%	贫血，心排血量增高性心力衰竭，缺氧(甲型地中海贫血)
胎儿宫内感染	5%～7%	贫血，缺氧，内皮细胞受损，毛细血管通透性增加
胸部发育异常	6%	上腔静脉阻塞，或因胸内压增加引起静脉回流受阻
双胎输血综合征	3%～10%	血容量增加和中心静脉压升高
尿路异常	2%～3%	尿路积水，肾病综合征伴低蛋白血症
胃肠发育异常	0.5%～4%	静脉回流障碍，胃肠道梗阻和梗死伴蛋白质丢失和胶体渗透压下降
淋巴管发育异常	5%～6%	静脉回流障碍
胎儿肿瘤，包括绒毛血管瘤	2%～3%	贫血，心排血量增高性心力衰竭，低蛋白血症
骨骼发育不良	3%～4%	肝大，低蛋白血症，静脉回流障碍
各种胎儿综合征	3%～4%	各种胎儿综合征
遗传代谢病	1%～2%	脏器增大和静脉回流障碍，红细胞生成减少，贫血和(或)低蛋白血症
混杂因素	3%～15%	-
未知因素	15%～25%	-

表1 NIHF的病因与HF发生率及其发生机制

NIHF病因	HF发生率	HF发生机制
心血管功能异常	17%～35%	中心静脉压升高
染色体异常	7%～16%	心脏结构或功能异常，淋巴发育不良，骨髓细胞异常生成
血液系统异常	4%～12%	贫血，心排血量增高性心力衰竭，缺氧(甲型地中海贫血)
胎儿宫内感染	5%～7%	贫血，缺氧，内皮细胞受损，毛细血管通透性增加
胸部发育异常	6%	上腔静脉阻塞，或因胸内压增加引起静脉回流受阻
双胎输血综合征	3%～10%	血容量增加和中心静脉压升高
尿路异常	2%～3%	尿路积水，肾病综合征伴低蛋白血症
胃肠发育异常	0.5%～4%	静脉回流障碍，胃肠道梗阻和梗死伴蛋白质丢失和胶体渗透压下降
淋巴管发育异常	5%～6%	静脉回流障碍
胎儿肿瘤，包括绒毛血管瘤	2%～3%	贫血，心排血量增高性心力衰竭，低蛋白血症
骨骼发育不良	3%～4%	肝大，低蛋白血症，静脉回流障碍
各种胎儿综合征	3%～4%	各种胎儿综合征
遗传代谢病	1%～2%	脏器增大和静脉回流障碍，红细胞生成减少，贫血和(或)低蛋白血症
混杂因素	3%～15%	-
未知因素	15%～25%	-

[1]	Teles Abrao Trad A, Czeresnia R, Elrefaei A, et al. What do we know about the diagnosis and management of mirror syndrome？[J]. J Matern-Fetal Neonat Med, 2021, 15: 1-6. DOI: 10.1080/14767058.2020.1844656.
[2]	Chen R, Liu M, Yan J, et al. Clinical characteristics of mirror syndrome: a retrospective study of 16 cases[J]. J Obstet Gynaecol, 2021, 41(1): 73-76. DOI: 10.1002/pd.2327.
[3]	孙路明，卫星，邹刚，等. 非免疫性胎儿水肿临床指南[J]. 中华妇产科杂志，2017, 52(11)：721-727. DOI: 10.3760/cma.j.issn.0529-567x.2017.11.001.
[4]	Mathias CR, Rizvi C. The diagnostic conundrum of maternal mirror syndrome progressing to pre-eclampsia-A case report[J]. Case report Women Health, 2019, 23: e00122. DOI: 10.1016/j.crwh.2019.e00122.
[5]	Hermyt E, Zmarzly N, Jeda-Golonka A, et al. Mirror syndrome: a literature review[J]. Pediatr Medycyn Rodzinn, 2019, 15(3): 246-251. DOI: 10.15557/PiMR.2019.0041.
[6]	Hobson SR, Wallace EM, Chan YF, et al. Mirroring preeclampsia: the molecular basis of Ballantyne syndrome[J]. J Matern-Fetal Neonat Med, 2020, 33(5): 768-773. DOI: 10.1080/14767058.2018.1500550.
[7]	Hirata G, Aoki S, Sakamaki K, et al. Clinical characteristics of mirror syndrome: a comparison of 10 cases of mirror syndrome with non-mirror syndrome fetal hydrops cases[J]. J Matern-Fetal Neonat Med, 2016, 29(16): 2630-2634. DOI: 10.3109/14767058.2015.1095880.
[8]	Waring GJ, Splitt M, Robson SC. Fetal hydrops: diagnosis and prognosis[J]. Arch Dis Child, 2019, 104(3): 209-210. DOI: 10.1136/archdischild-2018-315777.
[9]	Kumar B, Nazaretian SP, Ryan AJ, et al. Mirror syndrome: a rare entity[J]. Pathology, 2007, 39(3): 373-375. DOI: 10.1080/00313020701330458.
[10]	Braun T, Brauer M, Fuchs I, et al. Mirror syndrome: a systematic review of fetal associated conditions, maternal presentation and perinatal outcome[J]. Fetal Diagn Ther, 2010, 27(4): 191-203. DOI: 10.1159/000305096.
[11]	Allarakia S, Khayat HA, Karami MM, et al. Characteristics and management of mirror syndrome: a systematic review (1956-2016)[J]. J Perinat Med, 2017, 45(9): 1013-1021. DOI: 10.1515/jpm-2016-0422.
[12]	Kaiser I. Ballantyne and triple edema[J]. Am J Obstet Gynecol, 1971, 110(1): 115-120. DOI: 10.1016/0002-9378(71)90226-2.
[13]	Agrawal A, Hussain KS, Kumar A. Minor blood group incompatibility due to blood groups other than Rh (D) leading to hemolytic disease of fetus and newborn: a need for routine antibody screening during pregnancy[J]. Intractab Rare Dis Res, 2020, 9(1): 43-47. DOI: 10.5582/irdr.2019.01094.
[14]	Swearingen C, Colvin ZA, Leuthner SR. Nonimmune hydrops fetalis[J]. Clin Perinatol, 2019, 47(1): 105-121. DOI: 10.1016/j.clp.2019.10.001.
[15]	Sileo FG, Kulkarni A, Branescu I, et al. Non-immune fetal hydrops: etiology and outcome according to gestational age at diagnosis[J]. Ultrasound Obstet Gynecol, 2020, 56(3): 416-421. DOI: 10.1002/uog.22019.
[16]	Mardy AH, Chetty SP, Norton ME, et al. A system-based approach to the genetic etiologies of non-immune hydrops fetalis[J]. Prenat Diagn, 2019, 39(9): 732-750. DOI: 10.1002/pd.5479.
[17]	Society for Maternal-Fetal Medicine (SMFM), Norton ME, Chauhan SP, et al. Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis[J]. Am J Obstet Gynecol, 2015, 212(2): 127-139. DOI: 10.1016/j.ajog.2014.12.018.
[18]	Pais AS, Areia ALFA, Franco SMP, et al. Mirror syndrome associated with Patau syndrome: a case report[J]. Revist Brasil Ginecolog Obstet, 2018, 40(7): 430-432. DOI: 10.1055/s-0038-1653975.
[19]	Bellini C, Hennekam RC. Non-immune hydrops fetalis: a short review of etiology and pathophysiology[J]. Am J Med Genet A, 2012, 158A(3): 597-605. DOI: 10.1002/ajmg.a.34438.
[20]	Xu W, Smith CT, Binstock A, et al. Maternal mirror syndrome masquerading as congestive heart failure: a case report[J]. Practice, 2019, 12(11): 447-451. DOI: 10.1213/XAA.0000000000000965.
[21]	Umazume T, Morikawa M, Yamada T, et al. Changes in echocardiography and blood variables during and after development of Ballantyne syndrome[J]. Case Reports, 2016, 2016: bcr2016216012. DOI: 10.1136/bcr-2016-216012.
[22]	Navarro-Perez SF, Corona-Fernandez K, Rodriguez-Chavez JL, et al. Significant clinical manifestations in Ballantyne syndrome, after a case report and literature review: recognizing preeclampsia as a differential diagnosis[J]. Case Report Obstet Gynecol, 2019: 2013506, 2019. DOI: 10.1155/2019/2013506.
[23]	Goeden AM, Worthington D. Spontaneous resolution of mirror syndrome[J]. Obstet Gynecol, 2005, 106(5): 1183-1186. DOI: 10.1097/01.AOG.0000161062.95690.91.
[24]	Mangoub F, Bouhou RA, Idri Z, et al. Ballantyne syndrome complicated by eclampsia: about a case and literature review[J]. Pan Afr Med J, 2018, 30: 238. DOI: 10.11604/pamj.2018.30.238.15296.
[25]	Burwick RM, Pilliod RA, Dukhovny SE, et al. Fetal hydrops and the risk of severe preeclampsia[J]. J Matern-Fetal Neonat Med, 2019, 32(6): 961-965. DOI: 10.1080/14767058.2017.1396312.
[26]	Chimenea A, García-Díaz L, Calderón AM, et al. Resolution of maternal mirror syndrome after successful fetal intrauterine therapy: a case series[J]. BMC Pregnancy Childbirth, 2018, 18(1): 1-5. DOI: 10.1186/s12884-018-1718-0.
[27]	Masmejan S, Baud D, Ryan G, et al. Management of fetal tumors[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 58: 107-120. DOI: 10.1016/j.bpobgyn.2019.01.006.
[28]	Kino E, Maki Y, Ohhashi M, et al. A case of mirror syndrome caused by hydrops fetalis after fetoscopic laser photocoagulation[J]. Clin Case Report, 2018, 6(6): 1010-1013. DOI: 10.1002/ccr3.1513.eCollection2018Jun.
[29]	Isserman RS, Nelson O, Tran KM, et al. Risk factors for perioperative mortality and transfusion in sacrococcygeal teratoma resections[J]. Pediat Anesth, 2017, 27(7): 726-732. DOI: 10.1111/pan.13143.
[30]	Chen CP, Shaw SW, Chern SR, et al. Prenatal diagnosis and management of monozygotic twins discordant for severe fetal abnormalities[J]. Taiwan J Obstet Gynecol, 2020, 59(6): 945-947. DOI: 10.1016/j.tjog.2020.09.025.
[31]	Kontomanolis EN, Fasoulakis Z. Hydrops fetalis and the parvovirus B-19[J]. Cur Pediat Rev, 2018, 14(4): 239-252. DOI: 10.2174/1573396314666180820154340.

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[15]	Huijie Gao, Zhongying Wang, Yulian Hu, Hua Pan, Chao Liu. Expression changes of Lumican and autophagy-related proteins in placenta of patients with preeclampsia[J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(01): 35-39.

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