title: Mirror syndrome associated with hydropic acardius in triplet pregnancy.
abstract: Mirror syndrome is the association of triple edema, i.e. fetal, placental and maternal edema, with maternal preeclampsia. We here report the first case of mirror syndrome resulting from hydropic acardius in triplet pregnancy.
  
  
  RESULTS
  A 26-year-old nulliparous woman spontaneously conceived two living fetuses and one acardius, and suffered preterm rupture of the membranes at 23 2/7 weeks of gestation. We observed triple edema, hydropic acardius, placental edema, and maternal edema, together with maternal high blood pressure, proteinuria and low hematocrit, and therefore suspected the presence of mirror syndrome. Due to the prematurity of the fetuses, we closely observed her, awaiting fetal maturity. Three days later (23 5/7 weeks), cord prolapse occurred, leading to emergent cesarean section. Female infants, weighing 492 and 554 g, respectively, were born alive; the former died on the 13th postnatal day and the latter was healthy with no sequelae. An acardius weighing 860 g had vascular communication with the 492-gram fetus. Histological examination confirmed a monochorionic, triamniotic single placenta. The mother suffered from pulmonary edema and was treated in the intensive care unit under respiratory support, but soon improved.
  
  
  CONCLUSIONS
  When dealing with multifetal pregnancy, especially when complicated by an acardius, obstetricians must have the highest level of concern for the occurrence of mirror syndrome, a life-threatening condition both to the mother and the fetus.
authors.affiliation: Department of Obstetrics, Jichi Medical University, Tochigi, Japan. matsushi@jichi.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.forename: Takako
authors.initials: T
authors.lastname: Ohmaru
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.forename: Fujimi
authors.initials: F
authors.lastname: Arai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kuwata
authors.forename: Rie
authors.initials: R
authors.lastname: Usui
authors.forename: Kayo
authors.initials: K
authors.lastname: Takahashi
authors.forename: Akio
authors.initials: A
authors.lastname: Izumi
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000757:Anencephaly / Q000000981:diagnostic imaging; D002585:Cesarean Section; D004487:Edema / Q000000981:diagnostic imaging*; D017809:Fatal Outcome; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D010922:Placenta Diseases / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011256:Pregnancy Outcome; D014310:Triplets; D016216:Ultrasonography, Prenatal