First Trimester Abortion: A Rare Cause of Intrauterine Bony Spicules

Abstract

Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following first trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal.

Retained fetal bones: an unusual cause of abnormal uterine bleeding

“…It has been observed that levels of PG 2α decreases by 15% after removal of bony fragments. 6 In our case menometrorrhagia that occurred after surgical abortion would have been caused by retained bony pieces through similar mechanism. Srofenyoh et al reported 3 cases of retained fetal bones which presented as secondary infertility.…”

“…5 It usually presents as secondary infertility, menometrorrhagia, dysmenorrhea, vaginal discharge, pelvic pain, and spontaneous expulsion of bony fragments. 3,6 Mostly it has been diagnosed during workup of secondary infertility and accounts for 11.9% of foreign bodies removed from uterine cavity. 7 Secondary infertility may be caused by various mechanisms like formation of uterine synechiae or causing inflammation (IUCD like effects).…”

Intrauterine bony fragments - An unexpected finding in the hysterectomy specimen

“…In all these studies and many other single case reports, [5][6][7] most of the females presented with infertility and had a history of prior abortion. Other cases presented with pelvic pain, vaginal discharge and, abnormal uterine bleeding.…”

Retained Intra-uterine Foetal Bones Resulting in Secondary Infertility: A Case Report

“…Retained foetal bone has been thought to act as an intrauterine contraceptive device altering the uterine milieu and preventing implantation [8,9]. Other hypotheses as to why retained foetal bones lead to infertility include prevention of implantation because of obliteration of the uterine cavity and toxicity of bone particles on an implanted embryo [10].…”