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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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