Abstract
Objectives
For women with Swyer Syndrome, a 46,XY gonadal dysgenesis, full term pregnancies are possible after oocyte donation. According to literature, mode of delivery is almost always by Caesarean section for various reasons. Medical indications are multiple pregnancies and related complications, preeclampsia, an androgynous shaped pelvis and failed induction of labor. Elective Caesarean sections were performed based on maternal request and medical recommendation.
Methods
Following careful examination and shared decision making, we planned a spontaneous delivery with a patient with Swyer syndrome and tested the different hypotheses regarding anatomical and functional features according to literature. In addition, deliveries of women with Swyer Syndrome were analyzed in a German multicenter case series.
Results
A total of seven women with Swyer syndrome with a total of 10 pregnancies were identified, who later gave birth to twelve live-born children. Seven out of 10 births were performed by elective and non-elective Caesarean section, three births took place vaginally.
Conclusions
In summary, the risk of Caesarean section delivery has increased, but spontaneous delivery can be attempted in the event of inconspicuous findings.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Acknowledgments: We are indebted to the women who have participated in this study.
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Ethical approval: The study was conducted in accordance with the ethical principles found in the Declaration of Helsinki and the principles of Good Clinical Practice. The data examined in the present retrospective analysis were processed anonymously. An ethical approval was not required.
References
1. Coutin, AS, Hamy, A, Fondevilla, M, Savigny, B, Paineau, J, Visset, J. Pure 46XY gonadal dysgenesis. J Gynecol Obstet Biol Reprod 1996;25:792–6.Search in Google Scholar
2. Berglund, A, Johannsen, TH, Stochholm, K, Viuff, MH, Fedder, J, Main, KM, et al.. Morbidity, mortality, and socioeconomics in females with 46,XY disorders of sex development: a nationwide study. J Clin Endocrinol Metab 2018;103:1418–28. https://doi.org/10.1210/jc.2017-01888.Search in Google Scholar
3. Berglund, A, Johannsen, TH, Stochholm, K, Viuff, MH, Fedder, J, Main, KM, et al.. Incidence, prevalence, diagnostic delay, and clinical presentation of female 46,XY disorders of sex development. J Clin Endocrinol Metab 2016;101:4532–40. https://doi.org/10.1210/jc.2016-2248.Search in Google Scholar
4. Michala, L, Goswami, D, Creighton, SM, Conway, GS. Swyer syndrome: presentation and outcomes. BJOG 2008;115:737–41. https://doi.org/10.1111/j.1471-0528.2008.01703.x.Search in Google Scholar
5. Frydman, R, Parneix, I, Fries, N, Testart, J, Raymond, JP, Bouchard, P. Pregnancy in a 46, XY patient. Fertil Steril 1988;50:813–4. https://doi.org/10.1016/s0015-0282(16)60322-9.Search in Google Scholar
6. Fedder, J, Ørskov, M, Rubeck, PK. Pregnancies in XY women: is a weak myometrium cause of complications during pregnancy and delivery? Asian Pac J Reprod 2013;2:76–9. https://doi.org/10.1016/s2305-0500(13)60121-9.Search in Google Scholar
7. de Santis, M, Spagnuolo, T, Barone, D, Licameli, A. Successful twin pregnancy in a 46,XY pure gonadal dysgenesis. J Obstet Gynaecol 2013;33:737–9. https://doi.org/10.3109/01443615.2013.822480.Search in Google Scholar
8. Shah, JS, Viteri, OA, Longo, M, Abdallah, M, Sibai, B. Twin gestation in a Swyer syndrome patient with superimposed pre-eclampsia. J Obstet Gynaecol 2018;38:719–20. https://doi.org/10.1080/01443615.2017.1380615.Search in Google Scholar
9. Sauer, MV, Lobo, RA, Paulson, RJ. Successful twin pregnancy after embryo donation to a patient with XY gonadal-dysgenesis. AJOG 1989;161:380–1. https://doi.org/10.1016/0002-9378(89)90525-5.Search in Google Scholar
10. Chen, M-J, Yang, J-H, Mao, T-L, Ho, H-N, Yang, Y-S. Successful pregnancy in a gonadectomized woman with 46,XY gonadal dysgenesis and gonadoblastoma. Fertil Steril 2005;84:217. https://doi.org/10.1016/j.fertnstert.2004.11.087.Search in Google Scholar PubMed
11. Creatsas, G, Deligeoroglou, E, Tsimaris, P, Pantos, K, Kreatsa, M. Successful pregnancy in a Swyer syndrome patient with preexisting hypertension. Fertil Steril 2011;96:E83–E5. https://doi.org/10.1016/j.fertnstert.2011.05.061.Search in Google Scholar PubMed
12. Cornet, D, Alvarez, S, Antoine, JM, Tibi, C, Mandelbaum, J, Plachot, M, et al.. Pregnancies following ovum donation in gonadal-dysgenesis. Hum Reprod 1990;5:291–3. https://doi.org/10.1093/oxfordjournals.humrep.a137092.Search in Google Scholar
13. Dirnfeld, M, Bider, D, Abramovici, H, Calderon, I, Blumenfeld, Z. Subsequent successful pregnancy and delivery after intracytoplasmic sperm injection in a patient with XY gonadal dysgenesisms. Eur J Obstet Gynecol Reprod Biol 2000;88:101–2. https://doi.org/10.1016/s0301-2115(99)00110-4.Search in Google Scholar
14. Kan, AKD, Abdalla, HI, Oskarsson, T. Two successful pregnancies in a 46,XY patient. Hum Reprod 1997;12:1434–5. https://doi.org/10.1093/humrep/12.7.1434.Search in Google Scholar PubMed
15. Hilfiker-Kleiner, D, Kaminski, K, Podewski, E, Bonda, T, Schaefer, A, Sliwa, K, et al.. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007;128:589–600. https://doi.org/10.1016/j.cell.2006.12.036.Search in Google Scholar PubMed
16. Hilfiker-Kleiner, D, Meyer, GP, Schieffer, E, Goldmann, B, Podewski, E, Struman, I, et al.. Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. J Am Coll Cardiol 2007;50:2354–5. https://doi.org/10.1016/j.jacc.2007.10.006.Search in Google Scholar PubMed
17. Taneja, J, Ogutu, D, Ah-Moye, M. Rare successful pregnancy in a patient with Swyer syndrome. Case Rep Women’s Health 2016;12:1–2. https://doi.org/10.1016/j.crwh.2016.10.001.Search in Google Scholar PubMed PubMed Central
18. Murtinger, M, Hradecky, L, Spitzer, D, Zech, NH. Unexpected labor and successful twin birth to a pure gonadal dysgenetic woman. Arch Gynecol Obstet 2013;288:1425–6. https://doi.org/10.1007/s00404-013-2933-6.Search in Google Scholar PubMed
19. Sharma, S, Thomas, SS. Management of heart failure and cardiogenic shock in pregnancy. Curr Treat Options Cardiovasc Med 2019;21:83. https://doi.org/10.1007/s11936-019-0797-1.Search in Google Scholar PubMed
20. Kouhkan, A, Khamseh, ME, Pirjani, R, Moini, A, Arabipoor, A, Maroufizadeh, S, et al.. Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth 2018;18. https://doi.org/10.1186/s12884-018-2115-4.Search in Google Scholar PubMed PubMed Central
21. Shah, A, Parisaei, M, Garner, J. Obstetric complications of donor egg conception pregnancies. J Obstet Gynaecol India 2019;69:395–8. https://doi.org/10.1007/s13224-019-01211-9.Search in Google Scholar PubMed PubMed Central
22. Zollner, U, Dietl, J. Perinatal risks after IVF and ICSI. J Perinat Med 2013;41:17–22. https://doi.org/10.1515/jpm-2012-0097.Search in Google Scholar
23. Ko, P-C, Peng, H-H, Soong, Y-K, Chang, S-D. Triplet pregnancy complicated with one hydatidiform mole and preeclampsia in a 46,XY female with gonadal dysgenesis. Taiwan J Obstet Gynecol 2007;46:276–80. https://doi.org/10.1016/s1028-4559(08)60034-0.Search in Google Scholar
24. Miller, DA, Goodwin, TM, Gherman, RB, Paul, RH. Intrapartum rupture of the unscarred uterus. Obstet Gynecol 1997;89:671–3. https://doi.org/10.1016/s0029-7844(97)00073-2.Search in Google Scholar
25. Gardeil, F, Daly, S, Turner, MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol 1994;56:107–10.10.1016/0028-2243(94)90265-8Search in Google Scholar
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