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. 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.

mirror syndrome, sFLt-1/PLGF ratio, monochorionic twin, hydrops fetalis, anemia polycythemia sequence, preeclampsia, fetocide, pulmonary edema