Transplantation of the human uterus.

Human uterine transplantation was performed on 6 April 2000 on a 26-year-old female who lost her uterus 6 years earlier due to post-partum hemorrhage. The donor, a 46-year-old patient with multiloculated ovarian cysts, underwent a hysterectomy modified to preserve tissue and vascular integrity. The donor uterus was connected in the orthotopic position to the recipient's vaginal vault and additional fixation was achieved by shortening the uterosacral ligament. The uterine arteries and veins were extended using reversed segments of the great saphenous vein, then connected to the external iliac arteries and veins, respectively. Immunosuppression was maintained by oral cyclosporine A (4 mg/kg/body wt.), azathioprine (1 mg/kg/body wt.) and prednisolone (0.2 mg/kg/body wt.). Allograft rejection was monitored by Echo-Doppler studies, magnetic resonance imaging (MRI), and measurement of the CD4/CD8 ratio in peripheral blood by fluorescence activated cell sorter (FACS scan). An episode of acute rejection was treated and controlled on the ninth day with anti-thymocytic globulin (ATG). The transplanted uterus responded well to combined estrogen--progesterone therapy, with endometrial proliferation up to 18 mm. The patient had two episodes of withdrawal bleeding upon cessation of the hormonal therapy. Unfortunately, she developed acute vascular thrombosis 99 days after transplantation, and hysterectomy was necessary. Macro- and microscopic histopathological examination revealed acute thrombosis in the vessels of the uterine body, with resulting infarction. Both fallopian tubes remained viable, however, with no evidence of rejection. The acute vascular occlusion appeared to be caused by inadequate uterine structure support, which led to probable tension, torsion, or kinking of the connected vascular uterine grafts.

Anthropometric measurement of newborns of gestational diabetic mothers: does it indicate disproportionate fetal growth?

Anthropometric and skinfold measurements in 51 newborns of mothers with gestational diabetes were compared to reference ranges obtained from measurements of 501 newborns of nondiabetic mothers. In newborns of diabetic mothers, the means of fetal birth weight, biceps, subscapular, suprailiac skinfolds, and total fat index measurements (the sum of all measurements) were significantly greater than those of the nondiabetic group. While the means of fetal crown-heel length and head circumference did not significantly differ between the two groups, these findings suggest a disproportionate pattern of growth in fetuses of diabetic mothers, with increased tendency for deposition of subcutaneous fat. The studied population were then stratified into six categories according to birth weight percentiles. Within each category, the skinfold measurements in newborns of diabetic mothers were greater--though the difference was not statistically significant than that of nondiabetic mothers. It is possible, however, that in severe cases of maternal diabetes, the risks of complications, such as shoulder dystocia, increase with disproportionate deposition of subcutaneous fat. These risks appear greater than in fetuses of nondiabetic mothers at a comparable birthweight.

Determinants of pregnancy outcome in patients with gestational diabetes.

OBJECTIVES: To describe the experience of management of gestational diabetes 'GDM' among a high-risk population and to determine the relative contribution of maternal risk factors and some indices of glucose intolerance on pregnancy outcome. METHODS: A total of 173 antenatal patients with GDM, matched to 337 non-diabetic controls were evaluated. Incidences of fetal macrosomia, large birth weight (> 4000 g), and operative delivery were noted. Patients with GDM were subgrouped into group I and II, according to the fasting blood glucose (FBG) level on the glucose tolerance test 'GTT', whether > or = or < 5.8 mmol/l, respectively. A logistic regression model was then developed with predictive variables, i.e. maternal weight, height, parity, gestational week at diagnosis of GDM, degree of glucose tolerance, treatment and means of fasting and post-prandial blood glucose measurements as independent variables against each of the outcome measures as dependent variables. RESULTS: Compared with non-diabetics, patients with GDM were older in age, weight and parity. The mean fetal birth weight, incidences of macrosomia and babies > 4 kg were significantly higher among GDM patients. In patients with GDM the degree of glucose intolerance (determined by FBG on the GTT) and maternal weight were the only variables that significantly increased the risk of macrosomia and operative delivery. Within group I patients (FBG > or = 5.8 mg/dl) only 'maternal weight' significantly increased the risk of both having a baby > 4 kg, and operative delivery. CONCLUSION: Among patients with gestational diabetes, a GTT with a FBG level > or = 5.8 mmol/l is a strong predictor for perinatal outcome. Maternal weight is an independent risk factor that increases the risk of both macrosomia and operative delivery.