Mirror syndrome

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Mirror syndrome or triple oedema or Ballantyne syndrome is a rare disorder affecting pregnant women. It describes the unusual association of fetal and placental hydrops with maternal preeclampsia.[1]

The name "mirror syndrome" refers to the similarity between maternal oedema and fetal hydrops. It was first described in 1892 by John William Ballantyne.[2]


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.[3][4][5][6] Ballantyne syndrome can result from the maternal reaction to a fetus that has hemoglobin Bart's disease due to inherited double thalassemia trait from both parents.[7]


The etiopathogenetic mechanism of Ballantyne syndrome remains unknown.

Signs and symptoms[edit]

Ballantyne syndrome has several characteristics:

The fetal symptoms are related to fluid retention, including ascites and polyhydramnios.[8] Fetal hydrops suggests the presence of an important and probably fatal fetal pathology.

It can be associated with twin-to-twin transfusion syndrome.[9]


Although the exact etiopathogenetic mechanism of Ballantyne syndrome remains unknown, several authors have reported raised uric acid levels, anemia, and low hematocrit without hemolysis.[1]

Differential diagnosis[edit]

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.[6][10][11][12][13]


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


  1. ^ a b Paternoster DM, Manganelli F, Minucci D, Nanhornguè KN, Memmo A, Bertoldini M, Nicolini U (2006). "Ballantyne Syndrome: a Case Report". Fetal Diagnosis and Therapy. 21 (1): 92–5. PMID 16354984. doi:10.1159/000089056. 
  2. ^ http://www.whonamedit.com/synd.cfm/616.html
  3. ^ Balakumar K (2003). "Antenatal diagnosis of vein of Galen aneurysm: case report". Indian Journal of Radiology and Imaging. 13 (1): 91–2. 
  4. ^ Carbillon L, Oury JF, Guerin JM, Azancot A, Blot P (1997). "Clinical biological features of Ballantyne syndrome and the role of placental hydrops". Obstetrical & Gynecological Survey. 52 (5): 310–4. doi:10.1097/00006254-199705000-00023. 
  5. ^ Machado LE, Osborne NG, Bonilla-Musoles F (2002). "Two-dimensional and three-dimensional ultrasound of fetal (baby) anasarca: the glass baby". Journal of Perinatal Medicine. 30 (1): 105–10. PMID 11933650. doi:10.1515/JPM.2002.013. 
  6. ^ a b Van Selm M, Kanhai HH, Gravenhorst JB (1991). "Maternal hydrops syndrome: a review". Obstetrical & Gynecological Survey. 46 (12): 785–8. doi:10.1097/00006254-199112000-00001. 
  7. ^ http://sogc.org/wp-content/uploads/2013/01/gui218CPG0810.pdf
  8. ^ Vidaeff AC, Pschirrer ER, Mastrobattista JM, Gilstrap LC, Ramin SM (2002). "Mirror syndrome. A case report". The Journal of reproductive medicine. 47 (9): 770–4. PMID 12380459. 
  9. ^ Chang YL, Chao AS, Hsu JJ, Chang SD, Soong YK (2007). "Selective fetocide reversed mirror syndrome in a dichorionic triplet pregnancy with severe twin-twin transfusion syndrome: a case report". Fetal. Diagn. Ther. 22 (6): 428–30. PMID 17652930. doi:10.1159/000106348. 
  10. ^ Pirhonen JP, Hartgil TW (2004). "Spontaneous reversal of mirror syndrome in a twin pregnancy after a single fetal death". European Journal of Obstetrics & Gynecology and Reproductive Biology. 116: 106–7. doi:10.1016/j.ejogrb.2003.12.011. 
  11. ^ Gherman RB, Incerpi MH, Wing DA, Goodwin TM (1998). "Ballantyne syndrome: is placental ischemia the etiology?". Journal of Maternal-Fetal Medicine. 7 (5): 227–9. PMID 9775990. doi:10.1002/(SICI)1520-6661(199809/10)7:5<227::AID-MFM3>3.0.CO;2-I. 
  12. ^ Heyborne KD, Chism DM (2000). "Reversal of Ballantyne syndrome by selective second-trimester fetal termination. A case report". Journal of Reproductive Medicine. 45 (4): 360–2. PMID 10804498. 
  13. ^ Midgley DY, Harding K (2000). "The mirror syndrome". European Journal of Obstetrics & Gynecology and Reproductive Biology. 88 (2): 201–2. doi:10.1016/S0301-2115(99)00147-5.