Hysteroscopic removal of intrauterine retained fetal bones

Abstract

Fetus papyraceus is a well-recognized complication of missed abortion or intrauterine fetal death. However, prolonged intrauterine retention of parts of the fetal skeleton is not adequately reported in the literature. Prolonged retention of intrauterine bone is a recognized cause of secondary infertility. Literature regarding endometrial ossification contains more than 80 cases, with 80% occurring after pregnancy. Common symptoms include menorrhagia, menometrorraghia, pelvic pain and infertility. Several theories have been proposed to explain osseous tissue within the uterine cavity. The most widely accepted is that ossification represents retained fetal bones following spontaneous, missed, incomplete or therapeutic abortion, suggesting that the fetus achieved at least 12 weeks gestation in order for endochondral ossification to occur. In contemporary gynecology, transvaginal sonographic diagnosis of retained fetal bones is made and the bones removed with the help of a resectoscope. Hysteroscopy is invaluable in achieving a cure for these patients without resorting to more aggressive surgery. Gonadotropin-releasing hormone analogues (GnRHa) have many new uses in gynecology. Several clinical studies have demonstrated a mean decrease in uterine volume after about 3–6 months of therapy. These patients might be candidates for GnRHa therapy so that a smaller corpus with an atrophic endometrium might aid in hysteroscopic retrieval of the retained bony fragments.