Ballantyne Syndrome: Maternal Mirror of Fetal Hydrops, Diagnostic Challenges, And Contemporary Management

Ballantyne syndrome, also known as mirror syndrome or triple edema, is a rare obstetric disorder characterized by the association of fetal hydrops, placentomegaly, and maternal edema. The syndrome reflects a maternal systemic response to severe fetal and placental hydrops and may closely resemble preeclampsia. Maternal manifestations include generalized edema, rapid weight gain, hypertension, proteinuria, dyspnea, pulmonary edema, and laboratory abnormalities. A key distinguishing feature from classic preeclampsia is maternal hemodilution rather than hemoconcentration. Ballantyne syndrome may occur with immune or non-immune fetal hydrops, including rhesus isoimmunization, parvovirus B19 infection, twin-to-twin transfusion syndrome, fetal structural cardiac disease, placental tumors, fetal tumors, chromosomal abnormalities, and vascular malformations. Perinatal prognosis is poor, with high rates of intrauterine fetal death and neonatal mortality. Management depends on identifying whether the underlying cause of fetal hydrops is reversible. When fetal therapy is possible, correction of the fetal condition may lead to maternal improvement and continuation of pregnancy. When hydrops is irreversible or maternal status deteriorates, delivery or pregnancy termination is often required. This review summarizes the definition, pathophysiology, etiologies, diagnostic approach, differentiation from preeclampsia, maternal and fetal outcomes, and management principles of Ballantyne syndrome.