Arun Sanap
Endoworld Hospital, IndiaPresentation Title:
Hysteroscopic removal of retained fetal bones
Abstract
A 34-years old, female, P4A2 (last being surgical abortions
at gestation of 15 weeks in a hospital 3 years
back), presented with complains of secondary infertility, pain in abdomen and
vaginal discharge of 3-4 months duration. On examination, her vitals were
normal and abdomen was unremarkable. Pelvic examination showed a normal sized
anteverted uterus and free bilateral fornices. Ultrasonography (USG) revealed
multiple linear calcific lesions in endometrial cavity. Hysteroscopy unveiled
the presence of macerated fetal bone fragments in the uterine cavity. They were
removed with hysteroscopic grasper and confirmed by histopathology. Recovery of
the patient in post-operative period was uneventful and the subsequent
menstrual cycles were normal. She was free of complains on follow up period of
6 months and trying to conceive naturally.
Fetal bone remains may present in endometrial cavity after
second-trimester abortion because of the unsafe abortion practices, improper
technique or unskilled facility provider or after medical abortion. It may
present late with irregular menstrual cycles, vaginal discharge, abnormal
uterine bleeding, chronic pelvic pain, secondary infertility and recurrent
pregnancy losses. The differential diagnoses are usually IUCD or foreign body
or osseous metaplasia of the endometrium. It may act like IUCD causing chronic
inflammation of endometrium and preventing implantation. High index of
suspicion is required for the diagnosis of intrauterine retained fetal bones in
case of secondary infertility after surgical abortions, especially in the
country like India where the incidence of illegal second trimester abortions
was higher in the past. Completeness of second
trimester abortion should be ascertained by USG or by health care provider by
assessing all fetal parts (the fetus is generally delivered in tact) and the
entire placenta. Further in case of retained fetal bones, early diagnosis
and it’s removal can recover fertility, but prolonged retention can lead to
endometrial inflammatory damage and IVF failure.
Biography
Arun Sanap has completed his MBBS and MS in Obstetrics and Gynecology from Grant Government Medical College, Mumbai, India. He was fellow- gynecology endoscopy and IVF/ICSI at Endoworld Hospital, Chh. Sambhajinagar. He is serving as medical officer (gynecology) at Rural Hospital Majalgaon. He has multiple publications in various national and international journals.
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