Obstetrical and Pediatric Follow-Up After Uterus Transplantation
The ultimate goal of uterus transplantation is a successful pregnancy, with birth of a healthy baby. This has been accomplished repeatedly after live donor uterus transplantation and up until mid-2019, two times after deceased donor uterus transplantation. Pregnancy is established by embryo transfer in either natural cycle or hormone replacement cycle. After confirmation of viable pregnancy, by transvaginal ultrasound at around gestational week 7, the obstetrician/feto-maternal specialist takes over the responsibility of the medical controls of pregnancy. In the Swedish program, the pregnant woman, with a uterine allograft, is typically seen every second week from gestational week 8 until week 34. Starting from gestational week 35, these visits are weekly until delivery. The patient is seen for laboratory tests, by a midwife for routine controls and by an obstetrician for more specialized investigations including ultrasound. We recommend elective delivery from gestational week 37, although we are aware that deliveries were planned from week 35 regarding the first deliveries of the original Swedish study. Cesarean section is the preferred mode of delivery and so far there are no reports of any spontaneous vaginal deliveries. The four live births after uterus transplantation, that so far have been published, are reviewed in detail in the article. Children born after uterus transplantation should be followed up for many years concerning developmental parameters. Tests that are used in the Swedish studies are outlined in the chapter.