Mirror syndrome in complicated monochorionic twin pregnancy
Background: Mirror syndrome is a rare pregnancy complication that occurs with obvious placental hydrops in the presence of immune or non-immune hydrops fetalis. The clinical symptoms of the mirror syndrome bear similarities to those of preeclampsia, but unlike the latter, they are reversible as placental hydrops and hydrops fetalis resolve. Therefore, the differential diagnosis of the mirror syndrome and preeclampsia is very important and determines the tactics of managing a patient and the prognosis of this pregnancy.Kurtser M.A., Shamanova M.B., Malmberg O.L., Normantovich T.O., Nikolaeva E.V., Sukhanova D.I.
Case report: Our paper describes an observation of pregnant patients with monochorionic twins, whose pregnancy was complicated by anemia polycythemia sequence accompanied by evident placental hydrops and by the development of the mirror syndrome with clinical presentations of pulmonary edema. The described cases show the time course of changes in laboratory parameters, including angiogenic (PlGF) and antianginal (sFLt-1) factors. A decreased sFLt-1/PLGF ratio was noted as placental hydrops reversed, which made it possible to regard these changes as an additional laboratory tool for the differential diagnosis of the mirror syndrome with preeclampsia. The correctly diagnosed mirror syndrome determined the tactics of managing these patients and allowed a long-awaited pregnancy to be maintained in both cases.
Conclusion: The mirror syndrome and preeclampsia are needed to make a careful differential diagnosis. Determining the changes in the sFLt-1/PLGF ratio can be used as an additional laboratory differential diagnostic test.
Authors’ contributions: Kurtser M.A. – analysis of the findings; Shamanova M.B. – development of the design of the investigation, obtaining the data to be analyzed, review of publications on the topic of the article, analysis of the findings, writing the text of the manuscript; Normantovich T.O., Malmberg O.L., Nikolaeva E.V., Sukhanova D.I. – data collection, analysis of the findings.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
For citation: Kurtser M.A., Shamanova M.B., Malmberg O.L., Normantovich T.O.,
Nikolaeva E.V., Sukhanova D.I. Mirror syndrome in complicated monochorionic twin pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; 1: 123-128 (in Russian)
https://dx.doi.org/10.18565/aig.2022.316
Keywords
mirror syndrome
sFLt-1/PLGF ratio
monochorionic twin
hydrops fetalis
anemia polycythemia sequence
preeclampsia
fetocide
pulmonary edema
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Received 27.12.2022
Accepted 16.01.2023
About the Authors
Mark A. Kurtser, Dr. Med. Sci., Professor, Member of the Russian Academy of Sciences, Head of Department of Obstetrics and Gynecology, Pediatric Faculty,Pirogov Russian National Research Medical University, Ministry of Health of Russia; General Director, "Mother and Child" Group of Companies, Perinatal Center of
"Mother and Child" Group of Companies, 117209, Russia, Moscow, Sevastopol Ave., 24/1.
Maria B. Shamanova, Head of the Department of Miscarriage Treatment, MD GROUP Clinical Hospital, +7(495)332-20-78, m.shamanova@mcclinics.ru,
117209, Russia, Moscow, Sevastopol Ave., 24/1.
Olga L. Malmberg, PhD, Chief Specialist of ultrasound diagnostic, "Mother and Child" Group of Companies; Associate Professor at the Department of Ultrasound,
RMACPE, o.malmberg@mcclinics.ru, 117209, Russia, Moscow, Sevastopol Ave., 24/1.
Tatiana O. Normantovich, Chief Physician, MD GROUP Clinical Hospital, t.normantovich@mcclinics.ru, 117209, Russia, Moscow, Sevastopol Ave., 24/1.
Elena V. Nikolaeva, Head of the Clinical Diagnostic Laboratory, Perinatal Center of "Mother and Child" Group of Companies, +7(495)332-20-78,
e.nikolaeva@mcclinics.ru, 117209, Russia, Moscow, Sevastopol Ave., 24/1.
Daria I. Sukhanova, PhD, obstetrician-gynecologist at the Department of Miscarriage Treatment, MD GROUP Clinical Hospital,
117209, Russia, Moscow, Sevastopol Ave., 24/1.
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