Hydrops Fetalis and Mirror Syndrome Secondary to Rh-D Alloimmunization, Associated with Oligohydramnious: A Case Report
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Abstract
One of the most common causes of fetal anemia is red cell alloimmunization. The most common routes of maternal sensitization are via blood transfusion or fetomaternal hemorrhage. Antibodies can cross the placenta during pregnancies in alloimmunized women and, if the fetus is positive for these specific erythrocyte surface antigens, result in hemolysis of fetal erythrocytes and anemia. This in turn, can lead to potentially disastrous consequence for the fetus, such as Hydrops Fetalis (HF), a high-output cardiac failure syndrome. The standard treatment in fetuses with anemia is intrauterine transfusion (IUT). Mirror Syndrome (MS) is a rare condition in pregnancy, in which maternal edema in pregnancy is seen in association with severe fetal and/or placental hydrops. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also observed in preeclampsia, and hence, the two conditions may have a similar clinical presentation [1]. The clinical manifestations of this disease are complex. It is easily underdiagnosed and timely intervention is needed to prevent fetal and maternal morbidity. MS can be reversible when the underlying factors are identified and modified [2, 3]. If correction of the underlying fetal abnormality is not possible, the consensual treatment is to deliver the hydropic fetus and placenta, with improvement of the maternal condition shortly thereafter. We report a case of HF and MS secondary to Rh-D alloimmunization that did not respond to IUT.
[1] Mathias CR, Rizvi C. The diagnosis conundrum of maternal mirror syndrome progression to preeclampsia- A case report. Case Reports in Women’s Health 23(2019) e00122. https://doi.org/10.1016/j.crwh.2019.e00122 PMID:31193796]
[2] Brandao AM, Domingues AP, Fonseca EM, Miranda TM, Moura JP. Mirror syndrome after fetoscopic laser treatment- a case report. Rev Bras Ginecol Obstet 2016; 38(11): 576-579. https://doi.org/10.1055/s-0036-1593895[PMID:28008591]
[3] Li H, Gu WR. Mirror syndrome associated with heart failure in a pregnant woman: a case report. Int J Clin Exp Med 2015; 8(9): 16132-16136.
[4] Gautier E, Benachi A, Giovangrandi Y, et al. Fetal RhD genotyping by maternal serum analysis: A two-year ex- perience. Am J Obstet Gynecol 2005; 192:666-669. https://doi.org/10.1016/j.ajog.2004.10.632 [PMID:15746656]
[5] Sohan K, Carroll SG, De La Fuente S, et al. Analy- sis of outcome in hydrops fetalis in relation to ges- tational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001; 80:726-730. https://doi.org/10.1034/j.1600-0412.2001.080008726.x [PMID:11531615]
[6] Hamdan AH. Pediatric hydrops fetalis: Background, Pathophysiology, Etiology. Pediatrics: Cardiac Disease and Critical Care 2017. https://emedicine.medscape.com/ article/974571-overview#:~:text=The%20basic%20mech- anism%20for%20the,or%20decreased%20plasma%20 osmotic%20pressure.
[7] McLean LK, Hedriana HL, Lanouette JM, Hanss C, Haesslein. A retrospective review of isoimmunised preg- nancies managed by middle cerebral artery peak sys- tolic velocity. American journal of Obstetrics and Gyne- cology 2004; 190: 1732-1738. https://doi.org/10.1016/j. ajog.2004.02.060 [PMID:15284784]
[8] Ballantyne KIH. Triple edema. Am J Obstet Gyne- col 1971; 110: 115-120. https://doi.org/10.1016/0002- 9378(71)90226-2
[9] Ballantyne JW. The disease and deformities of the fetus. Edinburg: Oliver & Boyd; 1892.
[10] Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N. Mirror syndrome: a sys- tematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010; 27(4): 191-203. https://doi.org/10.1159/000305096 [PMID:20357423]
[11] Goa S, Mimura K, Kakigano A, Tomimatsu T. Nor- malisation of angiogenic imbalance after intrauterine transfusion for mirror syndrome caused by parvovirus B19. Fetal Diag Ther 2013; 34: 176-179. https://doi. org/10.1159/000348778 [PMID:23711762]
[12] Allarakia S, Khayat HA, Karami MM, et al. Characteristics and management of mirror syndrome : a systematic re- view (1956-2016). J Perinat. Med. 2017; 45(9):1013-1021. https://doi.org/10.1515/jpm-2016-0422 [PMID:28315852]
[13] Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N. Mirror syndrome: a sys- tematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010; 27: 191-203. https://doi.org/10.1159/000305096 [PMID:20357423]
[14] Baur AR, Springel EH. Erythrocyte alloimmunization in pregnancy. Obstetrics and Gynecology 2018. https:// emedicine.medscape.com/article/273995-overview#:~:- text=Maternal%20alloimmunization%2C%20also%20 known%20as,immunoglobulin%20G%20(IgG)%20anti- bodies.
[15] Moise KJ. Management of rhesus alloimmunization in pregnancy. Obstetrics and Gynecology 2002; 100(3): 600- 611. https://doi.org/10.1016/S0029-7844(02)02180-4
[16] Wafelman LS, Pollock BH, Kreutzer J, Richards DS, Hutchison AA. Nonimmune hydrops fetalis: fetal and neonatal outcome during 1983-1992. Biol Neonate 1999; 75(2): 73. https://doi.org/10.1159/000014080 [PMID:9852356]
[17] Jones T, Miesnik SR. Mirror syndrome: a rare, potentially life-threatening obstetric complications. Journal of Obstet- ric, Gynecology & Neonatal Nursing 2015; 44(1): S85. https://doi.org/10.1111/1552-6909.12594
[18] Society for Maternal-Fetal Medicine. (SMFM), Norton ME, Chauhan SP, Dashe JS. Society for Maternal-Fetal Med- icine (SFMF) clinical guidlinre#7: non-immune fetal hy- drops. Am J Obstet Gynecol 2015; 212(2): 127-139. https:// doi.org/10.1016/j.ajog.2014.12.018 [PMID:25557883]
[19] Silvi a F NP, K are n CF. Sign ificant c linical manife stations in Ballantyne syndrome, after a case report and literatur e review: r ecognizing p re e clampsia as a diffe rential diagno-sis. Case Rep. Obstet. Gynecol 2019; 2019 (7 pages). https://doi.org/10.1155/2019/2013506
[20] Espinoza J, Romero R, Nien JK, Kusanovic JP, Richani K, Gomez R, et al. A role of the anti-angiogenic factor sVEG- FR-1 in the mirror syndrome (Bullantyne syndrome). J Ma- tern Fetal Neonatal Med 2006; 19(10): 607-6143. https:// doi.org/10.1080/14767050600922677 [PMID:17118734]
[21] Prefumo F, Pagani G, Fratelli N, Benigni A, Frusca T. Increased concentrations of antoangiogenic factors in mirror syndrome complicating twin-to-twin transfusion syndrome. Prenat Diagn 2010; 30: 378-379. https://doi. org/10.1002/pd.2461 [PMID:20127899]
[22] De Oliveira L, Sass N, Boute T, Moron AF. SFlt-1 and PlGF levels in a patient with morror syndrome relat- ed to cytomegalovirus infection. Euro J Obstet Gynecol Repr Bio 2011; 158: 366-367. https://doi.org/10.1016/j. ejogrb.2011.04.049 [PMID:21621898]
[23] Carbillon L, Oury JF, Guerin JM, Azancot A, Blot P. Clinical biological features of Ballantyne syndrome and the role of placental hydrops. Obstet Gynecol Surv 1997; 52(5): 310- 314. https://doi.org/10.1097/00006254-199705000-00023 [PMID:9140132]
[24] Iciek R, Brazert M, Klejewski A, Pietryga M, Brazert J. Ballantyne syndrome (mirror syndrome) asso- ciated with severe non-immune fetal hydrops-a case report. Ginekol Pol 2015; 86(9): 706-711. https://doi.org/10.17772/gp/57845 [PMID:26665574]
[25] Giacobbe A, Grasso R, Interdonato ML, Lagana AS, Val- entina G, Triolo O, Mancuso A. An unusual form of mirror syndrome: a case report. J Matern Fetal Neonatal Med 2013; 26(3): 313-315. https://doi.org/10.3109/14767058.2 012.722734 [PMID:22957971]
[26] Rahimi-Sharba ff F, Sae id i N. Succe ssful mana gement of a complicated mirror syndrome: a case report. Case Reports in Clinical Practice 2019; 4(2): 61-63. https ://doi.org/10.18502/crcp.v4i
[27] Yeom W, Paik ES, An JJ, et al. Clinical characteristics and perinatal outcome of fetal hydrops. Obstet Gynecol Sci 2015; 58: 90-97. https://doi.org/10.5468/ogs.2015.58.2.90 [PMID:25798421].
[28] Eiland S, Cvetanovska E, Bjerre AH, Nyholm, Sundberg,Norgaard LN. Mirror syndrome is a rare complication in
pregnancy, characterized by edema and hydrops fetalis.Ugeskr Laeger 2017; 10(15): 179. [PMID: 28416051]
[29] Chimenea A, Gracia-Diaz L, Calderon AM, De Las Heras MM, Antinolo G. Resolusion of maternal mirror syndrome
after successful fetal intrauterine therapy: a case series.BMC Pregnancy and Chilbirth 2018; 18:85. https://doi.
org/10.1186/s12884-018-1718-0 [PMID:29625560]
[30] Tayler E, DeSimone C. Anesthetic management of maternal mirror syndrome. Int J Obstet Anesth 2014; 23(4):
386-389.https://doi.org/10.1016/j.ijoa.2014.05.003 [PMID:25066819]
[31] Vidaeff AC, Pschirrer ER, Mastrobatissta JM, Glistrap LC 3rd, Ramin SM. Mirror syndrome: a case report. J Repord
Med 2002; 47: 770-774. [PMID: 12380459]
[32] Shahar E, Birenbaum E, Inbar D, Brish M. Hypovolemic shock at birth due to extensive fetomaternal hemorrhage. Isr J Med Sci 1981; 17(6): 441-444.https://doi.org/10.1097/00006254-198206000-00019
[2] Brandao AM, Domingues AP, Fonseca EM, Miranda TM, Moura JP. Mirror syndrome after fetoscopic laser treatment- a case report. Rev Bras Ginecol Obstet 2016; 38(11): 576-579. https://doi.org/10.1055/s-0036-1593895[PMID:28008591]
[3] Li H, Gu WR. Mirror syndrome associated with heart failure in a pregnant woman: a case report. Int J Clin Exp Med 2015; 8(9): 16132-16136.
[4] Gautier E, Benachi A, Giovangrandi Y, et al. Fetal RhD genotyping by maternal serum analysis: A two-year ex- perience. Am J Obstet Gynecol 2005; 192:666-669. https://doi.org/10.1016/j.ajog.2004.10.632 [PMID:15746656]
[5] Sohan K, Carroll SG, De La Fuente S, et al. Analy- sis of outcome in hydrops fetalis in relation to ges- tational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001; 80:726-730. https://doi.org/10.1034/j.1600-0412.2001.080008726.x [PMID:11531615]
[6] Hamdan AH. Pediatric hydrops fetalis: Background, Pathophysiology, Etiology. Pediatrics: Cardiac Disease and Critical Care 2017. https://emedicine.medscape.com/ article/974571-overview#:~:text=The%20basic%20mech- anism%20for%20the,or%20decreased%20plasma%20 osmotic%20pressure.
[7] McLean LK, Hedriana HL, Lanouette JM, Hanss C, Haesslein. A retrospective review of isoimmunised preg- nancies managed by middle cerebral artery peak sys- tolic velocity. American journal of Obstetrics and Gyne- cology 2004; 190: 1732-1738. https://doi.org/10.1016/j. ajog.2004.02.060 [PMID:15284784]
[8] Ballantyne KIH. Triple edema. Am J Obstet Gyne- col 1971; 110: 115-120. https://doi.org/10.1016/0002- 9378(71)90226-2
[9] Ballantyne JW. The disease and deformities of the fetus. Edinburg: Oliver & Boyd; 1892.
[10] Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N. Mirror syndrome: a sys- tematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010; 27(4): 191-203. https://doi.org/10.1159/000305096 [PMID:20357423]
[11] Goa S, Mimura K, Kakigano A, Tomimatsu T. Nor- malisation of angiogenic imbalance after intrauterine transfusion for mirror syndrome caused by parvovirus B19. Fetal Diag Ther 2013; 34: 176-179. https://doi. org/10.1159/000348778 [PMID:23711762]
[12] Allarakia S, Khayat HA, Karami MM, et al. Characteristics and management of mirror syndrome : a systematic re- view (1956-2016). J Perinat. Med. 2017; 45(9):1013-1021. https://doi.org/10.1515/jpm-2016-0422 [PMID:28315852]
[13] Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, Sarioglu N. Mirror syndrome: a sys- tematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010; 27: 191-203. https://doi.org/10.1159/000305096 [PMID:20357423]
[14] Baur AR, Springel EH. Erythrocyte alloimmunization in pregnancy. Obstetrics and Gynecology 2018. https:// emedicine.medscape.com/article/273995-overview#:~:- text=Maternal%20alloimmunization%2C%20also%20 known%20as,immunoglobulin%20G%20(IgG)%20anti- bodies.
[15] Moise KJ. Management of rhesus alloimmunization in pregnancy. Obstetrics and Gynecology 2002; 100(3): 600- 611. https://doi.org/10.1016/S0029-7844(02)02180-4
[16] Wafelman LS, Pollock BH, Kreutzer J, Richards DS, Hutchison AA. Nonimmune hydrops fetalis: fetal and neonatal outcome during 1983-1992. Biol Neonate 1999; 75(2): 73. https://doi.org/10.1159/000014080 [PMID:9852356]
[17] Jones T, Miesnik SR. Mirror syndrome: a rare, potentially life-threatening obstetric complications. Journal of Obstet- ric, Gynecology & Neonatal Nursing 2015; 44(1): S85. https://doi.org/10.1111/1552-6909.12594
[18] Society for Maternal-Fetal Medicine. (SMFM), Norton ME, Chauhan SP, Dashe JS. Society for Maternal-Fetal Med- icine (SFMF) clinical guidlinre#7: non-immune fetal hy- drops. Am J Obstet Gynecol 2015; 212(2): 127-139. https:// doi.org/10.1016/j.ajog.2014.12.018 [PMID:25557883]
[19] Silvi a F NP, K are n CF. Sign ificant c linical manife stations in Ballantyne syndrome, after a case report and literatur e review: r ecognizing p re e clampsia as a diffe rential diagno-sis. Case Rep. Obstet. Gynecol 2019; 2019 (7 pages). https://doi.org/10.1155/2019/2013506
[20] Espinoza J, Romero R, Nien JK, Kusanovic JP, Richani K, Gomez R, et al. A role of the anti-angiogenic factor sVEG- FR-1 in the mirror syndrome (Bullantyne syndrome). J Ma- tern Fetal Neonatal Med 2006; 19(10): 607-6143. https:// doi.org/10.1080/14767050600922677 [PMID:17118734]
[21] Prefumo F, Pagani G, Fratelli N, Benigni A, Frusca T. Increased concentrations of antoangiogenic factors in mirror syndrome complicating twin-to-twin transfusion syndrome. Prenat Diagn 2010; 30: 378-379. https://doi. org/10.1002/pd.2461 [PMID:20127899]
[22] De Oliveira L, Sass N, Boute T, Moron AF. SFlt-1 and PlGF levels in a patient with morror syndrome relat- ed to cytomegalovirus infection. Euro J Obstet Gynecol Repr Bio 2011; 158: 366-367. https://doi.org/10.1016/j. ejogrb.2011.04.049 [PMID:21621898]
[23] Carbillon L, Oury JF, Guerin JM, Azancot A, Blot P. Clinical biological features of Ballantyne syndrome and the role of placental hydrops. Obstet Gynecol Surv 1997; 52(5): 310- 314. https://doi.org/10.1097/00006254-199705000-00023 [PMID:9140132]
[24] Iciek R, Brazert M, Klejewski A, Pietryga M, Brazert J. Ballantyne syndrome (mirror syndrome) asso- ciated with severe non-immune fetal hydrops-a case report. Ginekol Pol 2015; 86(9): 706-711. https://doi.org/10.17772/gp/57845 [PMID:26665574]
[25] Giacobbe A, Grasso R, Interdonato ML, Lagana AS, Val- entina G, Triolo O, Mancuso A. An unusual form of mirror syndrome: a case report. J Matern Fetal Neonatal Med 2013; 26(3): 313-315. https://doi.org/10.3109/14767058.2 012.722734 [PMID:22957971]
[26] Rahimi-Sharba ff F, Sae id i N. Succe ssful mana gement of a complicated mirror syndrome: a case report. Case Reports in Clinical Practice 2019; 4(2): 61-63. https ://doi.org/10.18502/crcp.v4i
[27] Yeom W, Paik ES, An JJ, et al. Clinical characteristics and perinatal outcome of fetal hydrops. Obstet Gynecol Sci 2015; 58: 90-97. https://doi.org/10.5468/ogs.2015.58.2.90 [PMID:25798421].
[28] Eiland S, Cvetanovska E, Bjerre AH, Nyholm, Sundberg,Norgaard LN. Mirror syndrome is a rare complication in
pregnancy, characterized by edema and hydrops fetalis.Ugeskr Laeger 2017; 10(15): 179. [PMID: 28416051]
[29] Chimenea A, Gracia-Diaz L, Calderon AM, De Las Heras MM, Antinolo G. Resolusion of maternal mirror syndrome
after successful fetal intrauterine therapy: a case series.BMC Pregnancy and Chilbirth 2018; 18:85. https://doi.
org/10.1186/s12884-018-1718-0 [PMID:29625560]
[30] Tayler E, DeSimone C. Anesthetic management of maternal mirror syndrome. Int J Obstet Anesth 2014; 23(4):
386-389.https://doi.org/10.1016/j.ijoa.2014.05.003 [PMID:25066819]
[31] Vidaeff AC, Pschirrer ER, Mastrobatissta JM, Glistrap LC 3rd, Ramin SM. Mirror syndrome: a case report. J Repord
Med 2002; 47: 770-774. [PMID: 12380459]
[32] Shahar E, Birenbaum E, Inbar D, Brish M. Hypovolemic shock at birth due to extensive fetomaternal hemorrhage. Isr J Med Sci 1981; 17(6): 441-444.https://doi.org/10.1097/00006254-198206000-00019
| Files | ||
| Issue | Vol 7 No 2 (2022): March-April | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i2.10781 | |
| Keywords | ||
| Alloimmunization Fetal Anemia Hydrops Fetalis Mirror Syndrome | ||
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How to Cite
1.
Rahimi-Sharbaf F, Shirazi M, saleh maasoumeh, Golshahi F. Hydrops Fetalis and Mirror Syndrome Secondary to Rh-D Alloimmunization, Associated with Oligohydramnious: A Case Report. CRCP. 2022;7(2):50-57.
