Anaesthetic management of the first caesarean birth following uterus transplantation in the United Kingdom

Summary We describe the anaesthetic management of the first caesarean birth following uterus transplantation in the United Kingdom. This remains a novel procedure globally, and there are important considerations for the anaesthetist. A 36‐year‐old female with a background of Mayer–Rokitansky–Küster–Hauser syndrome presented for caesarean birth at 34 +2 weeks' gestation following uterus transplantation and in vitro fertilisation. The principal challenges for the anaesthetist are the ongoing requirement for immunosuppression, a different surgical technique compared with that required for caesarean birth in the native uterus and increased risk of haemorrhage requiring careful management of uterotonics and blood products. We used a combined spinal–epidural technique to provide anaesthesia in preparation for a potentially prolonged procedure. We prepared for the possibility of major haemorrhage, including the use of cell salvage. A multidisciplinary team involving transplant physicians and surgeons, obstetric physicians, obstetricians, midwives and anaesthetists guided the care of the patient throughout. We expect that this procedure will become increasingly common in the United Kingdom as uterus transplantation becomes more established as a treatment for uterine factor infertility.