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A rare case of retained fetal bones

Dec 29, 2022

Summary

  • Intrauterine retention of fetal bones is a rare complication of unsafe abortion.
  • We discuss such a case here where a woman presents with irregular bleeding after abortion, the cause failed to get detected for a year.
  • Successful diagnosis was possible via pelvic ultrasound and radiography. Fetal bones were successfully removed using dilatation and evacuation.

Case presentation

Gloria had her first and second child at the age of 19 and 20 years respectively. Both pregnancies were uneventful. She got pregnant again after a couple of years but this time she had a missed abortion at 16 weeks. She underwent surgical evacuation of the uterus at a nearby private clinic.

Since the procedure, she started to have variable intermenstrual bleeding, a problem she had never faced before. In the first few months, the bleeding used to be mild and painless. She was not using any type of contraception.

She visited different clinics for treatment where she was prescribed antibiotics, NSAIDs, tranexamic acid, and progestogens, but these did not provide relief.

Even though she had not used any contraceptive device, she underwent a pelvic ultrasound at a local clinic which reported that she had an intrauterine contraceptive device (IUCD) in her uterine cavity!

She finally went to a reputed gynecologist where she was examined further.

Clinical examination

  • Patient looked pale.
  • Vital signs were normal.
  • Thyroid not enlarged.
  • Abdominal examination was unremarkable.
  • Speculum examination showed healthy cervix and vagina.
  • Uterus was bulky, anteverted, mobile, and both lateral fornices were clear.
  • Transvaginal sonography (TVS) was conducted where suspicion of fetal bone was noted.
  • Pelvic radiograph showed radio-opaque shadows which confirmed the findings!

Figure 1 X-ray of the pelvis showing radio-opaque shadows

Treatment

Hysteroscopy was not available at the clinic the patient was getting treated, hence dilatation and evacuation (D & E) under general anesthesia was planned.

14 tiny fetal bones were removed from the uterine cavity. The procedure was uneventful, and bleeding was minimal. She was discharged after being kept under observation for 24 hours.

Figure 2 Fetal bones removed from the uterine cavity

Follow-up

She followed-up for six months and no complaints were noted. It was concluded that the fetal bones were the cause of the abnormal uterine bleeding.

Discussion & conclusions

Retained fetal bone is a rare complication of abortion. It is mostly noted in the case of unsafe abortions, which is a common occurrence in low-income nations. In women presenting with abnormal bleeding post-abortion, retention of fetal bones should be considered as one of the causes. Transvaginal ultrasound is an excellent tool to detect this condition successfully.

Reference

  1. Hameed F, Shuja S. Retained Fetal Bones: Rare cause of Abnormal Uterine Bleeding. Pakistan J Med Sci. 2019;36(ICON-Suppl).

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