917 Pregnancy outcomes following uterus transplant

Abstract

To examine the maternal and fetal outcomes of pregnancies following uterus transplant. We conducted a retrospective cohort study of women attempting to conceive following uterus transplant at a single institution. Maternal and neonatal outcomes are reported for all pregnancies that resulted in live birth following uterus transplant from either living or deceased uterus donation. The indication for uterus transplant was absolute uterine factor infertility with the etiology being MRKH syndrome in all cases but one (previous hysterectomy). All uterus recipients received tacrolimus plus either azathioprine or everolimus as anti-rejection treatment. Twelve pregnancies carried to viability following uterus transplant between 2017-2020. Median maternal age at the time of delivery was 31 years (range 21-39 years). Fifty percent of pregnancies were delivered preterm (<37 weeks), with the median gestational age at delivery being 36w6d (range 30w6d - 38w0d). All infants were born via cesarean section. In five pregnancies (four first deliveries and one second) the uterine graft was removed at the same time as the cesarean section. Decision to remove uterus at time of cesarean section was made based on plans for future fertility. Median fetal weight was 2,890 gm (Range 1,770 g to 3,470 g). One infant was small for gestational age (2400 gm at 32w4d) and one was large for gestational age (2350 gm at 36w6d). Three mothers developed gestational hypertension and one was diagnosed with preeclampsia without severe features. Additional complications included single incidents of the following: placenta previa with antepartum hemorrhage requiring preterm delivery, PPROM at 35w5d gestation, and cervical dilation at 23w4d with rescue cerclage placement with delivery at 30w6d. Maternal or obstetric complications were present in eight of the twelve of the pregnancies. Pregnancies conceived following uterus transplant are successful in producing healthy, neonates with minimal risk of maternal complications.