An Overview of Mirror Syndrome

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Mirror syndrome is another term for what is also known as Ballantyne Syndrome or triple edema. It occurs in pregnancy when the fetus has an abnormal excess of fluid and the woman has preeclampsia, a form of hypertension or high blood pressure. It is a rare condition. However, when it does occur it is extremely serious and potentially life-threatening.

Pregnancy complications such as mirror syndrome can be stressful and frightening, but recognizing the symptoms and telling your healthcare provider are the first steps toward appropriate diagnosis and treatment. Early action is important when something is atypical during pregnancy—this can make all the difference.

Mirror syndrome
Illustration by Nusha Ashjaee, Verywell  


It’s important to notice the symptoms of mirror syndrome as soon as possible in order to get appropriate treatment. Sometimes these symptoms can overlap with other conditions, like preeclampsia, so professional examination and diagnosis is crucial. Mirror syndrome can be confused with preeclampsia—it’s important to rule out mirror syndrome if you are diagnosed with preeclampsia as well.

Symptoms of mirror syndrome can include:

  • Significant, severe swelling
  • High blood pressure
  • Protein found in urine (easily diagnosed by a urine test at the doctor’s office)
  • Significant and excessive weight gain in a short period of time

Sometimes mirror syndrome will show up in a blood test through hemodilution (a condition in which there is more plasma in the blood and a lower number of red blood cells). This occurs because of excess fluid that has built up in the body.


Due to its rarity, the exact causes of mirror syndrome aren’t known. However, mirror syndrome is typically caused by something called fetal hydrops. Fetal hydrops is a condition in which fluid leaves the bloodstream and builds up in the tissues of the fetus. It can be caused by a variety of things depending on the type of fetal hydrops, but it often develops from complications that interfere with the natural ability of the fetus to regulate fluid.

The types of complications that cause fetal hydrops can include infection, genetic syndromes, heart problems, metabolic disorders, among others. In some cases, if a woman is pregnant with twins, twin-to-twin transfusion syndrome can cause fetal hydrops.

In turn, these complications can cause preeclampsia in the mother as a part of mirror syndrome in addition to fluid in the lungs.


There is no test specific to diagnose mirror syndrome. However, results from other tests can form an appropriate diagnosis. The excess fluid in the fetus is typically seen on ultrasound, and preeclampsia can be diagnosed by the pregnancy care provider based on blood pressure readings and/or protein in the urine.

These tests, along with self-reported symptoms and other signs the doctor or healthcare provider may observe, are valuable tools in making a diagnosis of mirror syndrome.


Since mirror syndrome is so rare, treatment can vary depending on the specific situation. Treatment can often depend on the underlying cause of the fetal hydrops as well as the severity of the preeclampsia. If the cause is known and can be treated, treating it may alleviate symptoms of mirror syndrome for both a mother and her baby.

In other cases, especially if the preeclampsia is serious, the delivery may be indicated and then the maternal symptoms will be relieved in a matter of days. After the baby is delivered, the newborn intensive care unit (NICU) staff will address the hydrops and provide appropriate treatment, depending on the underlying cause.

If you have any symptoms of mirror syndrome or preeclampsia, it’s important to take them seriously.

Be sure to mention any symptoms you may have, however minor, to your doctor or healthcare professional.

The symptoms may turn out to be normal pregnancy pains. If it turns out to be a cause for concern, however, it's better to speak about it as soon as you notice the signs. Talk with your obstetrical care provider about your signs and symptoms and any change in movement with your baby. Regular prenatal care will also be able to help with monitoring you for any signs of preeclampsia and fetal monitoring.

A Word From Verywell

While mirror syndrome is rare and potentially very serious, it is treatable. Even if you feel as though you may be overreacting to changes in your body, it's important to inform your doctor just in case. Early action is key in the diagnosis and treatment of mirror syndrome.


4 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mathias CR, Rizvi C. The diagnostic conundrum of maternal mirror syndrome progressing to pre-eclampsia - A case reportCase Rep Womens Health. 2019;23:e00122. doi:10.1016/j.crwh.2019.e00122

  2. Allarakia S, Khayat HA, Karami MM, Aldakhil AM, Kashi AM, Algain AH, Khan MA, Alghifees LS, Alsulami RE. Characteristics and management of mirror syndrome: a systematic review (1956-2016). J Perinat Med. 2017 Dec 20;45(9):1013-1021. doi:10.1515/jpm-2016-0422. PMID:28315852.

  3. UPMC. What Is mirror syndrome?

  4. Stanford Children’s Health. Hydrops fetalis.

By Jaime R. Herndon, MS, MPH
Jaime Rochelle Herndon, MS, MPH, MFA, is a former writer for Verywell Family covering fertility, pregnancy, birth, and parenting.