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Case Reports
. 2021 Mar 15;14(3):e238583.
doi: 10.1136/bcr-2020-238583.

Delayed miscarriage inside an infected decidual cast: a rare complication of the Depo medroxyprogesterone acetate injection

Ryo Fukaura  1 , Alistair Ward  2 , Shreelata Datta  2
Affiliations
Case Reports

Delayed miscarriage inside an infected decidual cast: a rare complication of the Depo medroxyprogesterone acetate injection

Ryo Fukaura et al. BMJ Case Rep. .

Abstract

Decidualisation of the endometrium is a progesterone-mediated reaction that naturally occurs during a woman's menstrual cycle. The hyperproliferated tissue is then usually dissolved and passed in a menstrual period. Occasionally, the natural dissolution does not happen, and the tissue maintains the shape of the endometrium, forming a decidual cast. These casts are known to be formed secondary to the use and/or cessation of various contraceptive methods. Here, we report a case of a patient presenting with passage of a decidual cast secondary to cessation of the Depo medroxyprogesterone acetate injection. This is the first reported case of the cast becoming infected, and also the first case of a decidual cast containing old products of conception.

Keywords: contraception; obstetrics and gynaecology; pregnancy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT image taken in emergency department. We can see a mass in the endocervical canal.
Figure 2
Figure 2
Ultrasound image of the uterus after the patient had passed the mass. The uterus is empty.
Figure 3
Figure 3
Solid tissue passed per vagina by the patient.
See this image and copyright information in PMC

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References

    1. Westhoff C. Depot-medroxyprogesterone acetate injection (Depo-Provera): a highly effective contraceptive option with proven long-term safety. Contraception 2003;68:75–87. 10.1016/S0010-7824(03)00136-7 - DOI - PubMed
    1. FSRH Clinical Effectiveness Unit . FSRH clinical guidance: Progesterone-only injectable 2014.
    1. Howard DL, Wayman R, Strickland JL. Satisfaction with and intention to continue Depo-Provera versus the Mirena IUD among post-partum adolescents through 12 months of follow-up. J Pediatr Adolesc Gynecol 2013;26:358–65. 10.1016/j.jpag.2013.07.013 - DOI - PubMed
    1. Harel Z, Biro FM, Kollar LM, et al. . Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives Depo-Provera and Norplant. J Adolesc Health 1996;19:118–23. 10.1016/1054-139X(95)00322-J - DOI - PubMed
    1. Polaneczky M, Liblanc M. Long-Term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents. J Adolesc Health 1998;23:81–8. 10.1016/S1054-139X(98)00014-7 - DOI - PubMed

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