Undiagnosed mirror syndrome with maternal hypoxemia onset during an emergency cesarean section: A case report

Mirror syndrome is a rare pregnancy condition in which maternal edema is associated with fetal hydrops. Because of its rarity and overlapping symptoms, this condition is often misdiagnosed as another pregnancy complication.

A 28-year-old pregnant Japanese woman presented with sudden 7.5-kg weight gain, leg edema, and increased d-dimer level.

Ultrasound revealed polyhydramnios and fetal hydrops, and findings of maternal edema and blood test results were suggestive of Miller syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease.

An emergency cesarean section was performed under spinal anesthesia at 36 weeks and 2 days of- pregnancy. We could not diagnose mirror syndrome.

The newborn's Apgar scores were 2 and 5 at 1 and 5 minutes after delivery, respectively. The patient's SpO2 suddenly decreased to 86% during cesarean section and persisted for 2 days. Chest computed tomography revealed pleural effusion and pulmonary edema. The pleural effusions and lung edema spontaneously resolved after the cesarean section.

This case reports on Miller syndrome with maternal hypoxemia onset during an emergency cesarean section and highlights the potential for better perioperative management and improvement in maternal mortality through prompt diagnosis and appropriate treatment shared not only among obstetricians and pediatricians but also among anesthesiologists.