A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: A case report

Abstract

Abstract Background: Ritodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma.Case presentation: A 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation was administered continuous intravenous ritodrine for preterm uterine contractions. After one week of tocolytics, she presented with elevated serum levels of creatinine kinase (CK), acute kidney injury, impaired liver function and pulmonary edema. Ultrasound showed hydrops fetalis, polyhydramnios and placental thickening. Because of progressive dyspnea and rhabdomyolysis, emergency cesarean section was performed at 27 1/7 weeks of gestation. A 1000-g female infant with general subcutaneous edema was delivered and had an Apgar score of 1 at 1 min and 3 at 5 min. In addition, an 8.5-cm placental chorioangioma was found during the operation. After cesarean section and the cessation of intravenous ritodrine, her symptoms and laboratory indicators improved gradually during the postpartum period. It is difficult to identify mirror syndrome and ritodrine-induced pulmonary edema. Thus, this case is educational and worthy of discussion.Conclusion: Our case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload.