EP17.77: Postpartum atypical mirror syndrome complicating a woman treated for mirror syndrome in antepartum period: a near miss case report

A 26-year-old gravida 4, para 3 mother presented with the complaint of decreased fetal movement of 3 days duration at the gestational age of 27 weeks. She had associated generalised body swelling. She was admitted with the diagnosis of fetal immune hydrops for intrauterine transfusion (IUT). IUT was done two times and she was in close follow-up. After three days she developed high blood pressure (160/90mmHg) and liver enzymes were elevated two times. Considering pre-eclampsia, seizure prophylaxis, and antihypertensive treatment started. Following stabilization; she was counselled about the possibility of mirror syndrome, complications, and prognosis. The woman had decided on expectant management. Following the fourth IUT; fetal anemia was corrected; fetal hydrops and maternal symptoms were improved. Antihypertensive was de-escalated and stopped at 32 weeks. The woman was discharged after counselling. At 36 weeks she delivered a 2.6kg male neonate with good health. On 4th postpartum day, the woman again developed significant ascites, pleural effusion, and massive edema. Her blood pressure was normal range. She was admitted to the medical ward with the diagnosis of severe hypoalbuminemia. After the recommendation of our fetomaternal unit; atypical Mirror Syndrome was considered. Pelvic ultrasound revealed a significant piece of hydropic decidua with fluid collection in the endometrial cavity. The endometrium was evacuated using a manual vacuum aspirator on the sixth day. She was put on Lasix 40mg IV TID and there was a need for more blood transfusions. She had significant improvement within 24 hours. Finally, the woman and her newborn were discharged improved on the 12th postpartum day. Mirror Syndrome can be treated successfully in the antepartum period and may lead to complete recovery of both the mother and the fetus. Atypical mirror syndrome can happen in the postpartum period. Aggressive diuresis and postpartum endometrial evacuation fastens the recovery.