Maternal "mirror" syndrome: Evaluating the benefits of fetal therapy

Joanna Sichitiu; Fawaz Alkazaleh; Roel de Heus; Nimrah Abbasi; Tim van Mieghem; Johannes Keunen; Rory Windrim; Gareth Seaward; Edmond N Kelly; Liesbeth Lewi; Jan Deprest; Greg Ryan; Shiri Shinar

doi:10.1002/pd.6589

Maternal "mirror" syndrome: Evaluating the benefits of fetal therapy

Prenat Diagn. 2024 May 16. doi: 10.1002/pd.6589. Online ahead of print.

Authors

Joanna Sichitiu^{1

2

3}, Fawaz Alkazaleh^{1

2}, Roel de Heus^{1

2}, Nimrah Abbasi^{1

2}, Tim van Mieghem^{1

2}, Johannes Keunen^{1

2}, Rory Windrim^{1

2}, Gareth Seaward^{1

2}, Edmond N Kelly^{2

4}, Liesbeth Lewi⁵, Jan Deprest⁵, Greg Ryan^{1

2}, Shiri Shinar^{1

2}

Affiliations

¹ Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
² Ontario Fetal Centre, Toronto, Ontario, Canada.
³ Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁴ Division of Neonatology, Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium.

PMID: 38752664
DOI: 10.1002/pd.6589

Abstract

Objective: To evaluate maternal and perinatal outcomes following fetal intervention in the context of maternal "mirror" syndrome.

Study design: A multicenter retrospective study of all cases of fetal hydrops complicated by maternal "mirror" syndrome and treated by any form of fetal therapy between 1995 and 2022. Medical records and ultrasound images of all cases were reviewed. "Mirror" syndrome was defined as fetal hydrops and/or placentomegaly associated with the maternal development of pronounced edema, with or without pre-eclampsia. Fetal hydrops was defined as the presence of abnormal fluid collections in ≥2 body cavities.

Results: Twenty-one pregnancies met the inclusion criteria. Causes of fetal hydrops and/or placentomegaly included fetal lung lesions (n = 9), twin-twin transfusion syndrome (n = 6), severe fetal anemia (n = 4), and others (n = 2). Mean gestational age at "mirror" presentation was 27.0 ± 3.8 weeks. Maternal "mirror" syndrome was identified following fetal therapeutic intervention in 14 cases (66.6%). "Mirror" symptoms resolved or significantly improved before delivery in 8 (38.1%) cases with a mean interval from fetal intervention to maternal recovery of 13.1 days (range 4-35). Three women needed to be delivered because of worsening "mirror" syndrome. Of the 21 pregnancies treated (27 fetuses), there were 15 (55.5%) livebirths, 7 (25.9%) neonatal deaths and 5 (18.5%) intra-uterine deaths.

Conclusion: Following successful treatment and resolution of fetal hydrops, maternal "mirror" syndrome can improve or sometimes completely resolve before delivery. Furthermore, the recognition that "mirror" syndrome may arise only after fetal intervention necessitates hightened patient maternal surveillance in cases of fetal hydrops.