Mirror syndrome in complicated monochorionic twin pregnancy

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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. 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/PLGFratio can be used as an additional laboratory differential diagnostic test.

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About the authors

Mark A. Kurtser

N.I. Pirogov Russian National Research Medical University; MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

Dr. Med. Sci., Professor, Member of the Russian Academy of Sciences, Head of Department of Obstetrics and Gynecology, Pediatric Faculty; General Director

Maria B. Shamanova

MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

Email: m.shamanova@mcdinics.ru
Head of the Department of Miscarriage Treatment

Olga L. Malmberg

MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

Email: o.malmberg@mcclinics.ru
PhD, Chief Specialist of ultrasound diagnostic

Tatiana O. Normantovich

MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

Email: t.normantovich@mcclinics.ru
Chief Physician

Elena V. Nikolaeva

MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

Email: e.nikolaeva@mcclinics.ru
Head of the Clinical Diagnostic Laboratory

Daria I. Sukhanova

MD GROUP Clinical Hospital, "Mother and Child" Group of Companies

PhD, obstetrician-gynecologist at the Department of Miscarriage Treatment


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