Abstract

PIP: This case study discusses a patient with prolonged intrauterine retention of parts of the fetal skeleton. A 22 year old black woman presented with secondary infertility. After almost 1 year of attempted diagnosis, a hysteroscopy was performed and a white-appearing tubular structure which was similar to the noncopper-bearing portion of an IUD appeared to be embedded in the fundus. Removal was difficult and the removed segments proved to be bone. Results indicated there were bits of fetal bone partially embedded at the fundal portion of the uterus for 6 years after an induced abortion. Curettage yielded several more bone bits; repeat hysteroscopy confirmed that the uterus was empty. The patient have an uneventful postoperative recovery and is being followed up. There appears to be no other previously published report of fetal bones retained for up to 5 years after an abortion by dilatation and curettage. These bones could have contributed to this patient's postabortion infection. The value of hysteroscopy was clearly demonstrated in this case. Curettage alone could have missed the bones but hysteroscopy enabled the physicians to visualize the bones and their location. The authors speculate that the presence of the bones acted as a uterine synechia or an IUD and thus prevented pregnancy. It is also possible that the presence of bones near the fundal region elevated endometrial postaglandin F2alpha concentration in that region and rendered her infertile.