The role of fetal therapy in the management of mirror syndrome: a narrative review.

Autor:	Gavin NR; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Connecticut School of Medicine, Storrs, CT, USA., Forrest AD; Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA., Rosner M; Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA., Miller JL; Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA., Baschat AA; Department of Gynecology and Obstetrics, Center for Fetal Therapy, The Johns Hopkins Hospital, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2024 Dec; Vol. 37 (1), pp. 2345307. Date of Electronic Publication: 2024 Apr 28.
DOI:	10.1080/14767058.2024.2345307
Abstrakt:	Objectives: Mirror syndrome (MS) is a condition characterized by the presence of maternal, fetal, and placental edema and is reversible through delivery or pregnancy termination. As fetal hydrops itself may be amenable to treatment, we sought to determine outcomes for MS primarily managed by fetal therapy through a narrative review of the literature and cases managed at our fetal center. Study Design: PubMed, Embase, Web of Science, Scopus, and Google Scholar databases were searched through January 2024 using key words: mirror syndrome, Ballantyne's syndrome, fetal hydrops, maternal hydrops, pseudotoxemia, triple edema, maternal recovery, fetal therapy, and resolution. Manuscripts describing primary management by fetal therapy that included maternal and fetal outcomes were identified. Clinical details of MS patients managed with fetal therapy at our center were also included for descriptive analysis. Results: 16 of 517 manuscripts (3.1%) described fetal therapy as the primary intended treatment in 17 patients. 3 patients managed at our center were included in the analysis. Among 20 patients undergoing primary fetal therapy for management of mirror syndrome, median gestational age of presentation was 24 weeks and 5 days gestation; predominant clinical findings were maternal edema (15/20), proteinuria (10/20), pulmonary edema (8/20), and hypertension (8/20); the primary laboratory abnormalities were anemia (8/20) and elevated creatinine or transaminases (5/20). Condition-specific fetal therapies led to resolution of hydrops in 17 (85%) cases and MS in 19 (95%) cases. The median time to hydrops resolution was 7.5 days and to resolution of mirror syndrome was 10 days. Fetal therapy prolonged pregnancy by a median of 10 weeks with a median gestational age of 35 weeks and 5 days at delivery. All women delivered for indications other than mirror syndrome and 19/20 fetuses survived. Conclusion: In appropriately selected cases, MS often resolves after fetal therapy of hydrops allowing for safe pregnancy prolongation with good maternal and infant outcomes.
Databáze:	MEDLINE
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