Obstetrical complications in gestational carrier pregnancies.

Objective: To report two cases of severe obstetrical complications in gestational carrier pregnancies and to review our clinical experience and compare our results with those reported in the literature.

Design: Retrospective analysis.

Setting: A university IVF program.

Patient(s): Women without a functioning uterus or those whose pregnancy would exacerbate a medical condition were enrolled in the gestational carrier pregnancy program.

Intervention(s): IVF cycles using oocytes from genetic mothers (or oocyte donors) were performed, with ET to gestational carriers.

Main Outcome Measure(s): Clinical pregnancy rates, obstetrical complications, and neonatal outcomes.

Result(s): Ten couples underwent a total of 13 cycles using gestational carriers. A clinical pregnancy rate of 69% (9/13) was achieved. An intrapartum hysterectomy and a late puerperal hysterectomy were required because of severe obstetrical complications. The late puerperal hysterectomy was performed for placenta accreta in a triplet gestation. This carrier sustained multiple cerebral infarcts and blindness. One triplet infant died secondary to a hypoplastic left ventricle and complications of prematurity. A second gestational carrier with a singleton gestation underwent a hysterectomy for a uterine rupture, and the infant has cerebral palsy.

Conclusion(s): The past medical and obstetrical histories of potential gestational carriers must be closely scrutinized, and candidates must be thoroughly counseled about the potential risks involved in the procedure.