Ultrasound and clinical manifestation of Mirror (Ballantyne’s, Triple Hydrops) Syndrome

Introduction. Mirror syndrome, also known as Ballantyne's syndrome or triple edema syndrome, is a rare complication of pregnancy that clinically manifests with generalized edema in the pregnant woman, and placental hypertrophy and fetal anasarca in ultrasound. At the middle of pregnancy, the woman begins to suffer from sudden weight gain, delusional anemia, hypoprotein/albuminemia, thrombocytopenia, severe edema, serous cavity effusions, and respiratory disorders, all combined with significant arterial hypertension and proteinuria, leading to a clinical picture resembling extremely early onset of severe preeclampsia, which often necessitates urgent termination of pregnancy with a very poor perinatal prognosis. With timely delivery, the symptoms of Ballantyne’s syndrome in the mother resolve spontaneously within three to seven days, further linking its clinical presentation to severe preeclampsia.

 Case report. We present a case of Ballantyne syndrome in a patient with a monochorionic diamniotic twin pregnancy following fetoscopic laser coagulation of placental anastomoses due to stage III twin-to-twin transfusion syndrome. The syndrome manifested with total subcutaneous edema, ascites, and pericardial effusion. The maternal clinical presentation included progressive generalized subcutaneous tissue edema, interstitial pulmonary edema, and persistent arterial hypertension. Due to the lack of clinical improvement despite intensive therapy, a joint decision with the patient was made to terminate the pregnancy, after which all clinical symptoms rapidly regressed. 

Conclusion. Ballantyne’s syndrome represents a life-threatening complication for both the mother and fetus during pregnancy, requiring further study to develop effective methods of prevention and management.

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