Mirror Syndrome

Mirror syndrome is a medical condition that can manifest itself during pregnancy. The cardinal symptoms are edema, fetal hydrops and maternal hypertension. Various underlying diseases can be considered as the cause, on which the therapy of the syndrome depends.

Mirror Syndrome

What is mirror syndrome?

Mirror syndrome is a set of symptoms that women can experience during pregnancy. The core symptoms are water retention in the mother’s body (edema) and in the fetus’ body (hydrops). The disease is very rare: The specialist literature describes significantly fewer than 100 cases.┬áSee ablogtophone for KS which stands for Korsakoff Syndrome.

However, researchers believe that practicing physicians often do not diagnose Mirror syndrome as such. Since water retention in the legs – especially in the calves and feet – is very common in women during pregnancy, it usually does not arouse suspicion. In addition, the clinical picture is very similar to the appearance of similar syndromes.

Mirror syndrome comes from the English word for “mirror”. The condition owes its name to the fact that maternal edema and fetal hydrops mirror each other. The Scottish doctor John Williams Ballantyne was the first to describe the condition. Occasionally, the term Ballantyne syndrome appears in the medical literature.


Various diseases can be considered as the cause of Mirror Syndrome. The exact mechanisms that lead to the development of the clinical picture require further research. A potential cause of Mirror syndrome is Rhesus incompatibility. Rhesus factor is a property of blood. In Rhesus positive individuals, the red blood cells possess the Rhesus factor antigen.

When Rhesus-positive and Rhesus-negative blood mix, an immune reaction occurs and the body mistakenly breaks down the red blood cells. Normally, the bloodstream of the mother and the unborn child are separated by the placental barrier; red blood cells are too large to cross this barrier. However, minor injuries, infections, and other circumstances can increase the permeability of the placental barrier, allowing maternal and fetal blood to come into direct contact.

Rhesus incompatibility leads to hemolytic (blood-dissolving) anemia in this way. Mirror syndrome is merely a symptomatic consequence. Another possible cause of Mirror syndrome is viral infections and birth defects. They can lead to the organism storing water or not being able to pump invading liquid out of the tissue.

In addition, feto- fetal transfusion syndrome is an underlying disease in Mirror syndrome. This is a circulatory and nutritional disorder that can occur in identical twins. As a rule, it leads to one of the twins developing worse.

Symptoms, Ailments & Signs

For Mirror syndrome, the simultaneous occurrence of water retention in the mother and the fetus is characteristic. Maternal edema can vary in severity, as can fetal hydrops. There is no specific threshold. Pregnant women with mirror syndrome also have increased blood pressure (hypertension).

This may manifest itself in headaches, dizziness, nausea, nosebleeds and sleep disturbances. Vision problems, severe thirst and difficulty breathing can also occur, particularly in particularly severe cases. In many cases, however, high blood pressure runs its course without any noticeable symptoms. Many of these symptoms also show up independently during pregnancy, which makes it difficult to diagnose mirror syndrome.

Another sign of the disease is the excessive excretion of proteins through the urine (proteinuria). Around 20 percent of all women suffer from proteinuria during pregnancy; mirror syndrome, on the other hand, is much rarer. The occurrence of a single symptom does not necessarily mean that mirror syndrome is present.

Diagnosis & course of disease

Doctors diagnose Mirror Syndrome by carefully examining the individual symptoms. At least one ultrasound scan is required to diagnose fetal hydrops. The swollen tissue is often visible in the ultrasound image. To diagnose proteinuria, pregnant women collect their urine over a 24-hour period.

The laboratory can then determine the amount of protein in the collected urine. Normal is 50-150 mg. In the differential diagnosis, doctors must rule out preeclampsia. Pregnancy poisoning can produce symptoms similar to Mirror syndrome. Furthermore, doctors must rule out confusion with the HELLP syndrome. Correct diagnosis is a prerequisite for effective treatment.


Mirror syndrome itself is a complication of pregnancy. It occurs very rarely and can usually only be treated by abortion. Very often, the life of the child cannot be saved. The mother’s symptoms only improve if the causes of dropsy and polyhydramnios can be eliminated.

The prognosis for the child depends on the gestational age and the underlying disease. The premature death of the unborn child is also possible. The risks of further serious complications increase with the duration of the pregnancy. It is therefore necessary for the life of the mother and sometimes also for the child to initiate the abortion or premature birth immediately.

Due to the good medical care, surviving children are less likely to have long-term damage than in the past. However, the trigger can also be a hereditary deformity. In these cases, the surviving child always suffers from a disability. Rare maternal complications include a severe fall in hemoglobin, circulatory collapse, and heart failure.

These complaints are often associated with the death of the embryo at the same time. Due to the right heart failure, pulmonary edema and pleural effusions can also occur, which can also be fatal. Due to the different causes and the rarity of Mirror syndrome, no general statement about the prognosis of this complication is possible.

When should you go to the doctor?

As a rule, when the mirror syndrome occurs, the expectant mother must definitely consult a doctor and have treatment carried out. Unfortunately, in most cases, the treatment ends with an abortion of the pregnancy, so that the child can no longer be saved. In many cases, the unborn child dies very early. If the pregnancy is already advanced, the doctor has to initiate a premature birth in Mirror syndrome. This saves the life of the mother and the life of the child. Since mirror syndrome can lead to very serious complications, urgent treatment is necessary.

The mother should consult the doctor if the symptoms of mirror syndrome appear during pregnancy. These include, for example, severe headaches, dizziness and nosebleeds. Vision problems and sleep disturbances can also occur. The main symptoms of mirror syndrome are severe thirst and breathing problems. If these symptoms occur during pregnancy, a doctor must be consulted in any case.

Treatment & Therapy

Treatment for Mirror syndrome depends on the underlying condition. A blood transfusion may be necessary to treat rhesus incompatibility. The pregnant woman receives blood that comes from a donor. The blood transfusion can, to a limited extent, replace the red blood cells that the body mistakenly breaks down during hemolysis. After birth, the child often requires intensive medical care.

Since fluid may also have accumulated in the lungs, breathing may need to be artificially assisted. Water can also accumulate in the cavities of the heart. Puncture of the affected tissue and other possible measures will help to remove the excess fluid. The newborn may also need a blood transfusion.

Depending on the health of the mother and child, it may be advisable for Mirror syndrome to give birth as early as possible. Normally, an early birth is associated with higher risks: In the case of Mirror syndrome, however, the risks of premature birth may be lower than the risks associated with this clinical picture with a normal-length pregnancy. Doctors and parents have to weigh up what is best for mother and child on a case-by-case basis.

Outlook & Forecast

As a complication of pregnancy, mirror syndrome is extremely serious. Fortunately, it occurs only very rarely, because even today it can often only be treated by terminating the pregnancy. Unfortunately, the life of the child cannot usually be saved and the mother’s symptoms only disappear if the triggers of polyhydramnios and dropsy can be eliminated. The prognosis for the unborn child depends on the month of pregnancy and the triggering clinical picture.

In most cases, the baby dies prematurely because the longer the high-risk pregnancy lasts, the more severe the complications become. Therefore, it is imperative for the life of mother and child to decide in favor of an abortion or a premature birth. If the baby survives this step, the prospects are relatively good today thanks to improved medical care, as long-term damage occurs less frequently.

If an inherited disease is the cause of Mirror syndrome, the newborn is likely to be disabled. But mirror syndrome does not only mean dire consequences for the baby, the mother also suffers complications such as a sharp drop in her hemoglobin level, circulatory collapse or heart failure. These symptoms are often associated with the immediate loss of the embryo.

If there is also right heart failure, the pregnant woman may experience pleural effusions or pulmonary edema, both of which can be fatal. From a medical point of view, however, due to the different triggers and the small number of known cases, no binding statement can be made about the prognosis of mirror syndrome without examining the affected person.


Since Mirror Syndrome is not an independent disease, but a consequence of various causes, general prevention is not possible. The complications resulting from Rh incompatibility can often be controlled with medication before Mirror syndrome develops.


Since the treatment of Mirror syndrome is relatively complex and lengthy, follow-up care focuses on managing the condition safely. Those affected should try to build up a positive attitude despite the adversity. Relaxation exercises and meditation can help calm and focus the mind.

Various complications and symptoms occur with Mirror syndrome, which can usually have a very negative impact on the life and quality of life of the person affected. The sleeping problems that occur can lead to irritability in the patient. It is not uncommon for Mirror syndrome to be associated with mental upsets or even depression. This should be clarified with a psychologist. Sometimes an accompanying therapy can help to better accept the difficult situation.

You can do that yourself

Since there is no causal therapy, the sick women should focus on their mental state. Due to the specific consequences of Mirror Syndrome, the fetus can die, which means that there can also be stillbirths. This circumstance is difficult for expectant parents to cope with. Therefore, it may be advisable to seek help from counseling centers. If difficulties arise within a relationship, couples therapy can also be advisable. Because it is precisely the cohesion based on partnership that is of considerable importance.

In addition, the women concerned should pay more attention to the basic rules of conduct during pregnancy. Sudden movements should be avoided, especially towards the end of pregnancy.

It is also helpful to lead a healthy lifestyle. It is true that no causal reduction in the risk of complications can be achieved in this way. However, a healthy lifestyle leads to a noticeable strengthening of the body, which improves wound healing abilities and physical resistance.