Maternal mirror syndrome: Causes, symptoms, management, treatment of MMS | Health

Maternal mirror syndrome (MMS) is a rare but potentially life-threatening condition that affects pregnant women and according to health experts, it occurs when a fetus has a severe medical condition that causes the mother’s body to mirror the symptoms. In MMS, the mother develops symptoms that mirror those of her fetus, including edema (swelling), hypertension (high blood pressure) and proteinuria (excess protein in the urine).

These symptoms can be severe and, if left untreated, can lead to serious complications for both the mother and the fetus. In an interview with HT Lifestyle, Dr Prasannalatha, Senior Obstetrician and Gynaecologist at Kamineni Hospitals in Hyderabad, revealed, “The exact cause of MMS is not fully understood, but it is believed to be related to an immune response. In some cases, the fetus may have a genetic condition that triggers an immune response in the mother’s body, leading to the development of MMS. In other cases, it may be related to an infection or other environmental factor. The diagnosis of MMS can be challenging because the symptoms can be similar to those of other pregnancy-related conditions, such as preeclampsia. However, doctors may suspect MMS if a pregnant woman presents with symptoms that do not improve with traditional treatments or if her symptoms closely mirror those of her fetus.”

She highlighted, “Treatment for MMS typically involves managing the symptoms and closely monitoring the health of both the mother and the fetus. In some cases, delivery may be necessary to protect the health of both the mother and the fetus. However, delivery may also pose risks, especially if the fetus is premature or has other medical complications. If you are pregnant and experiencing symptoms such as swelling, high blood pressure, or proteinuria, it is important to seek medical attention immediately. While MMS is rare, it can be a serious condition that requires prompt diagnosis and treatment. Early diagnosis and prompt treatment are essential for protecting the health of both the mother and the fetus. If you are pregnant and experiencing symptoms, it is important to seek medical attention right away.”

Dr Namrata Nagendra, Consultant Obstetrics and Gynaecology at Apollo Cradle and Children’s Hospital in Bangalore’s Koramangala, shared, “Maternal Mirror Syndrome (MMS) is also called Ballantyne Syndrome and is a rare condition in pregnancy. The condition is associated with the presence of fetal hydrops, placentomegaly, and maternal odema – a clinical triad. The term was coined as the odema in the mother mirrors that of her fetus and placenta. The overall incidence of MMS is 0.024% but has high morbidity of 50% for the mother and worse for the fetus. Any etiology of fetal hydrops (rhesus isoimmunisation, twin-to-twin transfusion syndrome, structural anomalies and fetal malignancies) can be the cause of MMS.”

She explained, “In the case of MMS, the mother can present with high blood pressure, odema, proteinuria, multiple organ failure, and the passage of a grape-like structure from the vagina. She may be ICT positive (Rh-negative pregnancy). She may have signs and symptoms of infections or blood work, which is positive for it and may suffer from Thalassemia. Further to the symptoms, the condition may lead to complications like Postpartum Haemorrhage, Placenta Accreta, Disseminated Intravascular Coagulation (DIC), ICU admission and HELLP Syndrome. To prevent Maternal Mirror Syndrome, good preconception counselling, testing for infections, good antenatal care, early diagnosis, and repeated follow-ups are of great help. In the case of already having developed MMS, the causes of fetal hydrops are treated. If that does not help, delivery of the fetus usually resolves the symptoms.”

Dr Tasneem Shah, Consultant Obstetrics and Gynaecology at Manipal Hospital in Bangalore’s Whitefield, elaborated, “A condition that is uncommon but severe and impacts pregnant women is called Mirror Syndrome, which is also known as Trigeminal Edema or Ballantyne Syndrome. Maternal mirror syndrome can be caused by a variety of factors such as RH (Rhesus) iso-immunisation, fetal infection, and metabolic disorders. In some instances, the maternal response to a fetus with haemoglobin, Barts Disease caused by a hereditary double alpha thalassemia trait from both parents can cause Ballantyne syndrome.”

She pointed out, “The mother may experience symptoms such as edema or swelling of the body, mild albuminuria which means high albumin is found in the urine – a sign of kidney disease and unusual preeclampsia or high blood pressure. The fetal symptoms are related to fluid retention such as ascites and polyhydramnios. Fetal hydrops is a sign of significant and potentially fatal fetal pathology. It can be associated with parvovirus B19 infections and twin-to-twin transfusion syndrome. Unfortunately, Ballantyne Syndrome frequently results in fetal or neonatal mortality; preeclampsia is the most common form of maternal involvement. Therefore, it is important to seek medical attention promptly if any symptoms related to Mirror Syndrome are suspected.”

According to Dr Rashmi Varshney Gupta, Associate Director, Obstetrics and Gynaecology at Max Healthcare in Dehradun, Ballantyne Syndrome is a very rare but potentially life threatening condition for both pregnant mother and her baby-in-uterus, which occurs generally in the second trimester of pregnancy. She said, “The pathogenesis behind the syndrome is generally various kind of dysregulation in the vasculature and angiogenesis factors of growing baby and placenta. Signs or symptoms of the disease start from rapid weight gain in mother during second trimester, swelling all over the body, hypertension, anaemia and proteinuria with elevated liver enzymes. All these signs mimic preeclampsia of pregnancy. The diagnosis can be confirmed by ultrasound, which shows foetal hydrops and polyhydramnios. There is swelling of placenta (placentomegaly) and collection of fluid in lungs, abdomen, heart and skin of foetus.”

She concluded, “Management of this condition require ICU care under a team of experts with experienced critical care specialists and obstetrician. Various type of cardiovascular supportive medicines and anti-hypertensives are given to the mother for foetus intrauterine blood transfusion and pleuroamniotic shunts are given by foetal medicine experts. Sometimes to save mother we have to terminate pregnancy prematurely, generally by vaginal delivery. In more than 65% of cases, the baby expires after delivery or in uterus due to disease or prematurity while morbidity remains in 50% for the mother due to hypertension and others problems. The risk of recurrence of this syndrome depends upon underline cause of the condition.”