人子宫移植后临床妊娠并成功分娩活产儿案例分析

Case analysis of clinical pregnancy and successful deliver living neonate after human uterus transplantation

目的探讨文献报道的人子宫移植后,在受者移植子宫内临床妊娠,并成功分娩活产儿的可行性,以及母儿结局分析。方法选择受者接受子宫移植后,在移植子宫内临床妊娠,并成功分娩活产儿的文献为研究对象。以“uterine transplantation”或“uterus transplantation”为英文检索词,“子宫移植”和“活产”为中文检索词,检索PubMed数据库、万方数据知识服务平台及中国知网数据库中,关于人子宫移植后,在移植子宫内临床妊娠,并成功分娩活产儿的文献,检索时间设定为各文献库建库至2018年12月。分析文献报道的接受子宫移植受者的临床病例资料,包括一般临床资料,孕期并发症、分娩及产后情况,母儿结局,以及分娩的活产新生儿情况等。结果①自检索文献中筛选符合本研究纳入与排除标准的文献共计15篇,均为国外文献。涉及子宫移植后在移植子宫内临床妊娠,并成功分娩活产儿的受者共计12例,分娩活产儿共计12例。②受者一般临床资料:66.7%(8/12)受者在瑞典接受子宫移植,并成功分娩活产儿。90.9%(10/11)受者接受子宫移植的原因为苗勒管发育不全(MRKH)综合征。58.3%(7/12)受者接受子宫移植的子宫供体,来源于与其有血缘关系的供者。91.7%(11/12)受者采取活体供体子宫移植,1例为死亡供体子宫移植。本组12例子宫移植受者的受孕方式,均为体外受精-胚胎移植(IVF-ET),并且均为单胚胎移植。在其孕期,多采用免疫抑制治疗预防移植物抗宿主反应,并采用宫颈活组织检查进行免疫监测。③受者孕期、分娩及产后情况:孕期主要的产科并发症为妊娠期高血压疾病及妊娠期肝内胆汁淤积症(ICP)。其中,10例受者分娩时的平均孕龄为34+孕周;12例受者采取剖宫产术分娩,并且剖宫产术中及产后24 h无大出血、死亡等严重并发症发生,75.0%(9/12)继续保留子宫,其中1例再次成功妊娠。④分娩的活产新生儿情况:12例新生儿中,11例新生儿的平均出生体重为2497 g;12例均无出生缺陷,1例有轻度呼吸窘迫症状,其余无新生儿相关并发症发生。对8例在瑞典分娩新生儿随访至年龄为2个月至3岁,均未见明显异常。结论子宫移植后,在移植子宫内临床妊娠,并成功分娩活产儿是可以实现的,并且受者及新生儿的预后均良好。对子宫移植受者孕期需严格按照高危妊娠积极管理。

Objective To explore the feasibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation,as well as the maternal and neonatal outcomes.Methods The literature of clinical pregnancy in the transplanted uterus and successful deliver living neonate after uterus transplantation were selected as research subjects.Using"uterine transplantation"or"uterus transplantation"as English search terms,and"uterine transplantation"and"live birth"as Chinese search terms,we searched literature about clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation from PubMed,Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure databases,and the search period was set from the establishment of each database to December 2018.The clinical case data of reported patients who received uterus transplantation(recipients)from these literature were analyzed,including general clinical data,complications during pregnancy,childbirth and postpartum conditions of the recipients,also maternal and fetal outcomes,and conditions of live birth neonates.Results①A total of 15 pieces of literature which met the inclusion and exclusion criteria of this study were selected,and all of which were reported from abroad.A total of 12 recipients who had clinical pregnancy and successfully deliver living neonate after uterus transplantation were involved in,and they delivered 12 live birth neonates.②General clinical data of recipients:66.7%(8/12)of recipients received a uterus transplantation in Sweden and successfully delivered living neonate.90.9%(10/11)of recipients received uterus transplantation due to Mayer-Rokitansky-Kuster-Hauser(MRKH)syndrome.58.3%(7/12)of recipients and the donors were related.91.7%(11/12)adopted living donor transplantation,and 1 case adopted dead donor transplantation.12 recipients were pregnant through in vitro fertilisation-embryo transfer(IVF-ET)and all had single embryo transfers.During pregnancy of recipients,immunosuppressive therapy was used to prevent graft versus host reaction,and cervical biopsy was used for immune monitoring.③Recipients′conditions of pregnancy period,childbirth and postpartum:The main obstetric complications during pregnancy were hypertensive disorders of pregnancy and intrahepatic cholestasis of pregnancy(ICP).The average gestational age at delivery of 10 recipients was 34+gestational weeks.The delivery modes of 12 recipients were cesarean section,and there were no serious complications,such as intraoperative bleeding and postpartum hemorrhage after 24 h of cesarean section,death etc.,75.0%(9/12)of recipients continued to retain uterus,and one of them succeeded in pregnancy again.④Live birth neonatal conditions:The average weight of 11 neonates was 2497 g among 12 live birth neonates;no birth defects were found in 12 neonates,only 1 neonate had mild respiratory distress and the rest did not have complications.The follow-up age of 8 neonates in Sweden ranged from 2 months to 3 years,and no obvious abnormalities were found.Conclusions There is a possibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation,and both recipient and neonate have good prognosis.Recipients must be taken active management in strict accordance with high-risk pregnancy.