The first Australian uterus transplantation procedure: A result of a long-term Australian-Swedish research collaboration.

AIMS: The aim is to report the results of Australia's first uterus transplantation (UTx). METHODS: Following long-standing collaboration between the Swedish and Australian teams, Human Research Ethics approval was obtained to perform six UTx procedures in a collaborative multi-site research study (Western Sydney Local District Health 2019/ETH13038), including Royal Hospital for Women, Prince of Wales Hospital, and Westmead Hospital in New Souh Wales. Surgeries were approved in both the live donor (LD) and deceased donor models in collaboration with the inaugural Swedish UTx team. RESULTS: This is the first UTx procedure to occur in Australia, involving a mother donating her uterus to her daughter. The total operative time for the donor was 9 h 54 min. Concurrently, recipient surgery was synchronised to minimise graft ischaemic time, and the total operative time for the recipient was 6 h 12 min. Surgery was by laparotomy in the LD and recipient. The total warm ischaemic time of the graft was 1 h 53 min, and the cold ischaemic time was 2 h 17 min (total ischaemic time 4 h 10 min). The patient's first menstruation occurred 33 days after the UTx procedure. CONCLUSION: Twenty-five years of Swedish and Australian collaboration has led to Australia's first successfully performed UTx surgery at The Royal Hospital for Women, Sydney, Australia.

Dichorionic twins discordant for body-stalk anomaly: a management challenge.

Body-stalk anomaly is a sporadic and rare maldevelopment disorder characterised by large abdominal wall defect, spinal deformity and rudimentary umbilical cord. It is considered a lethal condition as there are only few reports of survival but there was at least one case of long-term survival after neonatal surgery.Differential diagnosis includes isolated omphalocele or gastroschisis, short umbilical cord, amniotic band, limb body-wall complex and other polymalformative syndromes.There are few reports about the expectant prenatal management of the body stalk anomaly as the majority of prenatal diagnosed cases undergo early elective termination. Twin pregnancies discordant for the anomaly represent a challenge to prenatal management as a healthy fetus should also be considered.We describe a case of dichorionic-diamniotic twins discordant for body stalk anomaly which underwent selective feticide of the affected fetus late in pregnancy, in accordance with parents' decision focused on the neonatal well-being of the unaffected twin.

Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes.

INTRODUCTION: Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial. MATERIAL AND METHODS: Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed. RESULTS: Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found. CONCLUSION: Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.

Intraplacental Choriocarcinoma: Rare or Underdiagnosed? Report of 2 Cases Diagnosed after an Incomplete Miscarriage and a Preterm Spontaneous Vaginal Delivery.

Intraplacental choriocarcinoma is a rare malignant tumor diagnosed after an abortion, an ectopic pregnancy, or a term or preterm pregnancy or following the diagnosis of a hydatidiform mole. During pregnancy, it may be more common than reported, as most patients are asymptomatic and placental choriocarcinomas are usually inconspicuous macroscopically and are often mistaken for an infarct. Based upon a case study methodology, we describe 2 cases of intraplacental choriocarcinoma: the first case was identified in the product of a uterine curettage following an incomplete miscarriage and the second in one of the placentas of a bichorionic twin pregnancy. Maternal investigation did not reveal evidence of metastatic disease and neither did the infants' one in the second case. The two cases underwent maternal surveillance with serum hCG and remained disease-free until the present. In conclusion, intraplacental choriocarcinoma is easily underdiagnosed but with current treatment, even in the presence of metastasis, the prognosis is excellent. A routine microscopic examination of all the placentas and products of miscarriage can increase the real incidence of this entity and consequently improve its management.

Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass.

BACKGROUND: Bariatric surgery has been shown to improve many obesity related co-morbidities, including gestational diabetes mellitus (GDM). Recently, new diagnostic criteria for GDM following the International Association of Diabetes and Pregnancy Study Group recommendations were implemented. The objective of this study was to compare the use of 2 different GDM criteria in diagnostic and pregnancy outcome after Roux-en-Y gastric bypass (RYGB). METHODS: Pregnant women who had previously undergone RYGB (n = 30) were screened for GDM with Carpenter and Coustan (C&C) criteria (n = 18) or the new diagnostic criteria (n = 12). RESULTS: None of the patients screened using C&C criteria where diagnosed with GDM, while 50% of the patients screened with the new criteria had GDM. Among women that underwent oral glucose tolerance tests (OGTT) (n = 19) as required for the new diagnostic criteria, 57.9% developed reactive hypoglycemia. All women diagnosed with GDM had excellent metabolic control during pregnancy and comparing the outcome of these pregnancies and those of women without GDM, there were no significant differences regarding the age at time of surgery or at pregnancy, body mass index before surgery and pregnancy, parity, previous history of GDM, time from surgery to conception, weight lost until pregnancy, weight gain during pregnancy, gestational age at delivery, and birth weight adjusted for gestational age. CONCLUSION: New GDM diagnostic criteria in post-RYGB pregnant women increased the prevalence of GDM diagnostic without changing pregnancy outcomes. In addition, OGTTs were associated with a high rate of reactive hypoglycemia. These data suggest that alternative GDM diagnostic criteria are needed for these postbariatric patients.