108 Infertility from retained fetal bone after termination: Case report and literature review

Abstract

Primary Objective: To review the literature addressing symptoms of retained fetal content after termination. Secondary objective: To discuss a case of hysteroscopic management in a patient with retained fetal bone content after remote termination procedure. Case report and literature review in an Urban based healthcare system of a patient who underwent hysteroscopic removal of retained fetal bone after remote history of surgical termination. This report describes the case of a 37-year-old woman presenting for infertility who had a termination of pregnancy at 20 weeks 17 years prior. Upon ultrasound echogenic structures were seen in the cervix and further confirmed with MRI. Hysteroscopy revealed mature fetal bone which was then removed. Literature Review: In the literature, similar cases have an original presentation of secondary infertility. Studies of the underlying pathophysiology have shown that these patients have prostaglandin levels similar to those with intrauterine devices (IUD) (6). Thus, retained fetal bone in the uterus may cause an environment in the uterus similar to an IUD resulting in secondary infertility. Other instances of retained bone have been attributed to osseous metaplasia secondary to chronic inflammation of the uterus (7). This in addition to other causes of calcification must remain in the differential until ruled out. Retained products are not uncommon in patients with termination at an advanced gestational age. The presented case portrays an unusual finding in an infertility patient remote from her termination episode. Review of the images in this case may help providers consider retained bone as an alternative to causes of infertility in patients with a history of termination.