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

Autor: Sichitiu J; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada.; Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland., Alkazaleh F; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., de Heus R; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Abbasi N; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., van Mieghem T; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Keunen J; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Windrim R; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Seaward G; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Kelly EN; Ontario Fetal Centre, Toronto, Ontario, Canada.; Division of Neonatology, Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada., Lewi L; Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium., Deprest J; Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium., Ryan G; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada., Shinar S; Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.; Ontario Fetal Centre, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Prenatal diagnosis [Prenat Diagn] 2024 Jul; Vol. 44 (8), pp. 979-987. Date of Electronic Publication: 2024 May 16.
DOI: 10.1002/pd.6589
Abstrakt: 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.
(© 2024 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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