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.