Mirror syndrome

Signs and symptoms

Ballantyne syndrome has several characteristics:

• edema, always a key feature
• albuminuria of the mother, usually mild
• preeclampsia, unusual

The fetal symptoms are related to fluid retention, including ascites and polyhydramnios. Fetal hydrops suggests the presence of an important and probably fatal fetal pathology.

It can be associated with parvovirus B19 infection and with twin-to-twin transfusion syndrome.

Causes

The etiology may be any of the variety of obstetric problems that range from immunological disorders, including Rh-isoimmunization, to fetal infections, metabolic disorders, and fetal malformations. Ballantyne syndrome can result from the maternal reaction to a fetus that has hemoglobin Barts disease due to inherited double alpha thalassemia trait (alpha thalassemia major) from both parents.

Pathogenesis

The etiopathogenetic mechanism of Ballantyne syndrome remains unknown.

Diagnosis

Although the exact etiopathogenetic mechanism of Ballantyne syndrome remains unknown, several authors have reported raised uric acid levels, anemia, and low hematocrit without hemolysis.

Differential diagnosis

The problem of distinguishing (or not) between Ballantyne syndrome and preeclampsia is reflected in the diversity of terminology used and in the debate that surrounds the subject. It seems much more likely that an etiology of severe fetal hydrops may cause Ballantyne syndrome when the fetal status greatly worsens and that the syndrome is only a manifestation of the extreme severity of the fetus-placental pathology. Platelet count, aspartate transaminase, alanine transaminase, and haptoglobin are usually unaffected and may be used to distinguish mirror syndrome from HELLP syndrome.

Treatment

In most cases, Ballantyne syndrome causes fetal or neonatal death. In contrast, maternal involvement is limited at the most to preeclampsia.

References

References

1. (2006). "Ballantyne Syndrome: a Case Report". Fetal Diagnosis and Therapy.
2. "Ballantyne's syndrome".
3. (2002). "Mirror syndrome. A case report". The Journal of Reproductive Medicine.
4. (2007). "Selective fetocide reversed mirror syndrome in a dichorionic triplet pregnancy with severe twin-twin transfusion syndrome: a case report". Fetal Diagn. Ther..
5. Balakumar K. (2003). "Antenatal diagnosis of vein of Galen aneurysm: case report". Indian Journal of Radiology and Imaging.
6. (1997). "Clinical biological features of Ballantyne syndrome and the role of placental hydrops". Obstetrical & Gynecological Survey.
7. (2002). "Two-dimensional and three-dimensional ultrasound of fetal (baby) anasarca: the glass baby". Journal of Perinatal Medicine.
8. (1991). "Maternal hydrops syndrome: a review". Obstetrical & Gynecological Survey.
9. "Archived copy".
10. (2004). "Spontaneous reversal of mirror syndrome in a twin pregnancy after a single fetal death". European Journal of Obstetrics & Gynecology and Reproductive Biology.
11. (1998). "Ballantyne syndrome: is placental ischemia the etiology?". Journal of Maternal-Fetal Medicine.
12. (2000). "Reversal of Ballantyne syndrome by selective second-trimester fetal termination. A case report". Journal of Reproductive Medicine.
13. (2000). "The mirror syndrome". European Journal of Obstetrics & Gynecology and Reproductive Biology.