Ichikawa Shino, Saito Junichi, Noguchi Satoko, Saito Kurumi, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Perioperative Stress Management, Hirosaki, Japan.
Medicine (Baltimore). 2024 Dec 13;103(50):e40838. doi: 10.1097/MD.0000000000040838.
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.
镜像综合征是一种罕见的妊娠疾病，其中母体水肿与胎儿水肿相关。由于其罕见性和症状重叠，这种疾病常被误诊为另一种妊娠并发症。
一名28岁的日本孕妇出现体重突然增加7.5千克、腿部水肿以及D-二聚体水平升高。
超声检查显示羊水过多和胎儿水肿，母体水肿的检查结果和血液检测结果提示为米勒综合征。尽管如此，由于信息不足和该疾病的罕见性，患者最初被误诊。
在妊娠36周零2天时，在脊髓麻醉下进行了急诊剖宫产手术。我们未能诊断出镜像综合征。
新生儿出生后1分钟和5分钟时的阿氏评分分别为2分和5分。患者在剖宫产手术期间血氧饱和度突然降至86%，并持续了2天。胸部计算机断层扫描显示胸腔积液和肺水肿。剖宫产后胸腔积液和肺水肿自行消退。
本病例报告了在急诊剖宫产手术期间发生母体低氧血症的米勒综合征，并强调不仅产科医生和儿科医生，而且麻醉医生之间通过及时诊断和适当治疗进行更好的围手术期管理以及降低孕产妇死亡率的可能性。
