Ballantyne Syndrome (Mirror Syndrome) associated with severe non-immune fetal hydrops--a case report

The aim of the study was to present a case of rapidly progressing non-immune fetal hydrops (NIHF) of unknown etiology in a normal-karyotype fetus, accompanied by severe maternal edema, anemia, and hypoproteinemia. After the differential diagnosis, Ballantyne Syndrome (BS, Mirror Syndrome) was diagnosed.

We present a case of a 31-year-old multipara at 22/24 weeks of pregnancy presenting severe symptoms of non-immune fetal hydrops: subcutaneous edema, hydrothorax, ascites and placental edema associated with maternal edema, anemia and hypoproteinemia. After cardiovascular infectious, immune and morphological causes were excluded, amniocentesis was performed and confirmed normal female 46, XX karyotype. Since 22 weeks of pregnancy increasing maternal edema and anemia were observed. No hematological, cardiac or nephrological causes of this condition were found.

At 24 weeks of pregnancy intrauterine fetal demise was diagnosed and surgical evacuation (cesarean section) of the fetus was performed. Resolution of maternal edema, anemia, and hypoproteinemia was observed shortly after the delivery.

Based on our findings, it seems safe to conclude that BS may develop in pregnancy complicated by NIHF of unknown origin.