RESUMEN
Resumen ANTECEDENTES: El síndrome de Ballantyne es un cuadro poco frecuente asociado con hidrops fetal, en el que la madre refleja los síntomas fetales. Es decisivo diferenciarlo de la preeclampsia porque comparten signos de hipertensión y proteinuria. Su etiopatogenia se desconoce pero se han propuesto teorías asociadas con el desequilibrio entre factores angiogénicos y antiangiogénicos. CASO CLÍNICO: Paciente de 29 años, controlada en la consulta de Medicina Materno-Fetal debido al antecedente de síndrome de Ballantyne en el embarazo previo. En la ecografía de control a las 26 semanas se detectaron placentomegalia, ascitis fetal e incremento del líquido amniótico. Las ecografías posteriores demostraron polihidramnios e hidrops a las 28 semanas. Enseguida de la aparición del edema se estableció el diagnóstico de síndrome del espejo recidivante e hidrops no inmunitario. Se hospitalizó para drenaje del líquido. La amniorrexis se produjo a las 29 + 6 semanas. Una semana después se inició la dinámica uterina y el embarazo finalizó a las 31 semanas, después de la ruptura prematura de membranas. El neonato fue un varón de 3200 g, Apgar 2-6-8 al minuto, 5 y 10 minutos, respectivamente. Después del estudio postnatal se estableció el diagnóstico de perforación ileal múltiple. El recién nacido requirió 5 intervenciones quirúrgicas, con posoperatorio tórpido y se dio de alta a los 3 meses de vida. CONCLUSIONES: El síndrome del espejo es infradiagnosticado, a pesar de su potencial para complicar gravemente el embarazo asociado con hidrops. La recuperación de la madre suele ser favorable a los pocos días de posparto aunque la morbilidad y la mortalidad fetal son elevadas.
Abstract BACKGROUND: Ballantyne syndrome is characterized by the triad: fetal, placental and maternal edema. It is an uncommon condition associated with fetal hydrops, in which mother reflects fetal symptoms. It is essential to differentiate from preeclampsia, since there are common signs such as hypertension and proteinuria. Etiopathogenesis is unknown, although theories associated with an imbalance between angiogenic and antiangiogenic factors have been postulated. Treatment consists of ending the pregnancy or improving the fetal situation. CLINICAL CASE: We present the case of a 29-years pregnant woman controlled in the Maternal-Fetal Medicine Unit due to the history of Ballantyne Syndrome in the previous gestation. In the follow-up ultrasound performed at 26-weeks, placentomegaly, fetal ascites and increased amniotic fluid were detected. Subsequent ultrasounds showed polyhydramnios and fetal hydrops at 28-weeks. After maternal edema began, she was diagnosed with recurrent Mirror Syndrome and non-immune hydrops. Admission was indicated and amniodrainage was performed due to symptomatic polyhydramnios. Finally, premature rupture of membranes occurred at 29+6-weeks. She started uterine dynamic after one week, ending in a preterm delivery at 31-weeks after premature rupture of membranes. A 3200gr male was born with Apgar Scores 2-6-8 at 1, 5 and 10min respectively and, after postnatal study, he was diagnosed with multiple ileal perforation. Five surgical interventions were necessary, with a complicated postoperative period and could be discharged at 3 months of age. CONCLUSIONS: Mirror syndrome is an underdiagnosed pathology of unknown incidence that can seriously complicate gestation associated with fetal hydrops. Maternal recovery is favorable few days after delivery, but it leads to high fetal morbi-mortality.
RESUMEN
Ballantyne syndrome (triple edema syndrome or mirror syndrome) is characterized by maternal edema, placental edema and fetal hydrops, associated to hypertensive syndrome as a variant of preeclampsia. We report a case of prenatal diagnosis of Ballantyne syndrome. A patient diagnosed with anemia, edema and abdominal pain was hospitalized at 26 weeks of gestation. Serial obstetric ultrasound tomography imaging showed placental edema, severe oligohydroamnios, fetal hydrops, abnormal fetal umbilical Doppler measurements, and ultrasonographic signs of anemia. The patient developed hypertensive disorders of pregnancy, a cesarean section was performed and an 840 g male infant was born, Apgar 2-8, with sepsis and fetal anemia, who died two days after cesarean delivery. A literature review of Ballantyne Syndrome, its physiopathology and diagnosis is performed.
El síndrome de Ballantyne (o de triple edema o síndrome en espejo), se caracteriza por edema materno, edema placentario e hidrops fetal, asociadoun síndrome hipertensivo variante de la preeclampsia. Se presenta un caso clínico de diagnóstico prenatal de síndrome de Ballantyne. A las 26 semanas de gestación se hospitaliza paciente con diagnóstico de anemia, edema y dolor abdominal. Las ecotomografias obstétricas seriadas demuestran edema placentario, oligohidroamnios severo, hidrops fetal, alteración del Doppler umbilical fetal, y signos ultrasonográficos de anemia.La paciente evoluciona con sindrome hipertensivo del embarazo, se realiza cesárea y se obtiene un recién nacido de 840 g, sexo masculino, Apgar 2-8, con sepsis y anemia fetal que fallece al segundo día. Se realiza una revisión de la literatura, de la fisiopatología y diagnóstico del síndrome de Ballantyne.