Title:
Retained fetal bone post abortion causing infertility
Author:
Jiexin Cao1 (corresponding author, Jiexin.cao@wales.nhs.uk)
Carla Grubb1
Mian Khurshid1
Aparna Gumma1
Affiliation 1: Obstetrics and Gynaecology Department, Ysbyty Gwynedd, Bangor, Wales
Written consent has been obtained from the patient.
Introduction
Retained fetal bone fragment post abortion is a rare complication and it can be a cause of secondary infertility. (1) There is no widely available evidence for clinical signs of retained fetal bone fragment but thought to include dysmenorrhoea, menstrual irregularities, chronic pelvic pain and secondary infertility. (2) There is currently no agreed protocol or guidelines regarding the best management but most case reports and case series managed with hysteroscopic retrieval of the fetal bone fragment. We present a case of secondary infertility likely caused by retained fetal bone fragments, its challenges in diagnosis and discussion around current guidelines in diagnosis and managing such scenarios.
Case History
A 39 year old business manager was initially seen in general gynaecology clinic in 2018 with complaints of chronic pelvic pain and 2 years of infertility. Her pain is non-cyclical, spasmodic and often sudden onset. She is otherwise fit and well, only known to have recurrent herpes infection therefore taking acyclovir when needed. She has no drug allergy. She is active smoker, smoking 1-2 cigarrettes/day and drinks 20 units of alcohol/week. She has BMI 31.8. Previous obstetric history revealed mid-trimester abortion 20 years ago with surgical dilatation and curettage (D&C) at 20 weeks. Transvaginal ultrasound investigation (Figure.1) showed heterogenous echotexture in the anterior fundal wall containing a cystic area 8mm in size ?aetiology. Impression from the clinic was irritable bowel syndrome (IBS) but need to rule out adenomyosis. Therefore MRI scan was booked to investigate further and mebeverine was prescribed.