First European live birth following uterine and adnexal transposition for fertility preservation: a case report and overview of reported neonatal outcomes

Objective: To report the first live birth in Europe, and the fifth worldwide, after uterine and adnexal transposition (UT) for fertility preservation in rectal cancer, and to review all published neonatal outcomes after UT. Design: Single-patient case report with comprehensive review of reported live births after UT. Subject: A 28-year-old nulliparous woman with locally advanced rectal adenocarcinoma (uT3 N1 cM0, pMMR/MSS). Exposure: Laparoscopic UT before pelvic chemoradiation, followed by uterine reimplantation during total mesorectal excision. Main Outcome Measures: Obstetric and perinatal outcomes, and placental histopathology. Results: The patient conceived naturally 18 months after uterine reimplantation. Pregnancy was complicated by intrauterine growth restriction (IUGR) and oligohydramnios, leading to elective cesarean delivery at 37 + 1 weeks of a healthy male newborn (2110 g; Apgar 9/10/10). Placental histology revealed maternal vascular malperfusion. Review of the four previously published live births confirmed natural conceptions, cesarean deliveries at 36-38 weeks, and uniformly favorable neonatal outcomes, although three pregnancies were complicated by IUGR. Conclusion: Successful pregnancy and live birth are achievable after UT and subsequent uterine reimplantation. These cumulative cases demonstrate that a temporarily displaced and later reimplanted uterus can sustain gestation to term. Given the observed risk of impaired fetal growth, enhanced third-trimester surveillance and routine placental examination are recommended. Uterine transposition represents a promising fertility-preservation option for young women requiring pelvic radiotherapy.