Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review.

Acta Obstet Gynecol Scand

Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Published: November 2024

AI Article Synopsis

  • Uterus transplantation (UTx) is a treatment aimed at women with absolute uterine factor infertility, and this study reviews the outcomes of pregnancies following this procedure.
  • The research involved a systematic review of literature between 2010 and 2023, focusing on maternal and neonatal outcomes from cesarean deliveries post-UTx, though it found no comparative studies, relying instead on case reports and series, resulting in low certainty of evidence.
  • Out of 40 unique live births identified, all were delivered via cesarean section, with nearly half being emergency procedures, and a significant portion were delivered before 37 weeks, indicating increased risks for mothers and babies compared to standard cesarean deliveries.

Article Abstract

Introduction: Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx.

Material And Methods: The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202310052).

Results: Twenty-four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider-initiated births.

Conclusions: The maternal and perinatal outcomes of 40 live births post-UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established.

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Source
http://dx.doi.org/10.1111/aogs.15003DOI Listing

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