Johannesson Liza, Testa Giuliano, Borries Trevor M, Wall Anji, Ma Tsung-Wei, Eagle Elizabeth A, Jain Akshaya, Taylor Sherri D, dePrisco Gregory, Gregg Anthony R
Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas.
Am J Perinatol. 2024 May;41(S 01):e1264-e1272. doi: 10.1055/a-2008-8361. Epub 2023 Jan 6.
Doppler velocimetry of the uterine and umbilical arteries is used to predict preeclampsia and monitor fetal outcomes. There have been no reports of Doppler velocimetry indices in pregnancies conceived after uterus transplantation, which differ from traditional pregnancies because of different uterine vascular inflow and outflow and exposure to immunosuppressive agents. We sought to examine whether Doppler indices can be used to predict embryo transfer success after uterus transplantation and whether Doppler indices across pregnancy predict fetal growth restriction.
This was a single-center cohort observational study of 14 uterus transplant recipients who underwent embryo transfer. Of these, 12 women successfully delivered 14 babies. Five Doppler investigations were performed within the cohort: (1) prepregnancy; (2) uterine artery assessment across pregnancy; (3) umbilical artery assessment across pregnancy; (4) successive pregnancies; and (5) fetal growth.
Prepregnancy uterine artery Doppler indices did not correlate with successful implantation after embryo transfer. Uterine artery Doppler indices in uterus transplant recipients decreased across pregnancy as described in pregnancies without uterus transplantation. The umbilical artery systolic/diastolic velocity ratio was lower at all weeks of gestation after uterus transplantation compared with values described in pregnancies without uterus transplantation. In those women who delivered two successive babies after uterus transplant, umbilical artery Doppler indices were significantly lower during the second pregnancy. There was always forward flow throughout diastole in the umbilical arteries, and no babies experienced fetal growth restriction.
In our study, uterus transplantation was not associated with abnormal blood flow indices in either the uterine or umbilical arteries. Although Doppler indices were not predictive of embryo transfer success, they supported the expectation that pregnancies after uterus transplantation at our center result in normally grown babies.
· Uterus transplantation is not associated with abnormal blood flow indices.. · Prepregnancy uterine artery Doppler indices did not correlate with successful embryo implantation.. · Doppler assessment supports the expectation of normal placentation, fetal growth, and healthy live births after uterus transplantation..
子宫动脉和脐动脉的多普勒测速用于预测先兆子痫并监测胎儿结局。子宫移植后妊娠的多普勒测速指标尚无相关报道，此类妊娠因子宫血管流入和流出不同以及暴露于免疫抑制剂而与传统妊娠有所不同。我们旨在研究多普勒指标是否可用于预测子宫移植后胚胎移植的成功与否，以及整个孕期的多普勒指标是否能预测胎儿生长受限。
这是一项对14名接受胚胎移植的子宫移植受者进行的单中心队列观察性研究。其中，12名女性成功分娩了14名婴儿。在该队列中进行了五项多普勒检查：（1）妊娠前；（2）整个孕期的子宫动脉评估；（3）整个孕期的脐动脉评估；（4）连续妊娠；（5）胎儿生长情况。
妊娠前子宫动脉多普勒指标与胚胎移植后的成功着床无相关性。子宫移植受者的子宫动脉多普勒指标在整个孕期如未行子宫移植的妊娠一样下降。与未行子宫移植的妊娠相比，子宫移植后各孕周的脐动脉收缩期/舒张期速度比均较低。在子宫移植后分娩两个连续婴儿的女性中，第二次妊娠期间脐动脉多普勒指标显著较低。脐动脉在整个舒张期始终存在正向血流，且无婴儿出现胎儿生长受限。
在我们的研究中，子宫移植与子宫或脐动脉的血流指数异常无关。尽管多普勒指标不能预测胚胎移植的成功与否，但它们支持了我们中心子宫移植后妊娠可生出正常发育婴儿的预期。
·子宫移植与血流指数异常无关。·妊娠前子宫动脉多普勒指标与胚胎成功着床无相关性。·多普勒评估支持子宫移植后胎盘正常形成、胎儿生长及健康活产的预期。
