Abstract

Introduction: Abnormal uterine bleeding is a common gynaecological problem with most common causes being fibroid, polyp, endometritis, neoplasia and coagulation disorder. Retained intrauterine fetal bone chips is a well recognised complication following either spontaneous or induced abortion but it is a rare cause of AUB. If not recognised in time it can lead to a long term sequelae of chronic pelvic pain and secondary iinfertility. Incidence reported in literature is 0.15% among the patients undergoing hysteroscopy. We report a case when this complication was recognised early and treated with no future consequence. Removal of retained intrauterine fetal bone chips can be done by dilatation and curettage or hysteroscopically but latter is more safe and leads to complete resolution of symptoms.

Case Report: A 32 year old women, para one, presented with complaints of irregular bleeding per vaginum, occasional passage of bony fragments with white discharge per vaginum, and pelvic pain following surgical termination of 16weeks gestation. Transvaginal ultrasound scan confirmed a bright hyperechogenic shadow in region of endometrial cavity suggestive of a fetal bone. Patient was put up for operative hysteroscopy at our centre and retained intrauterine fetalbone chips  were removed  under general anaesthesia.

Conclusion: Removal of retained intrauterine fetal bone chips by operative hysteroscopy under direct vision facilitates complete removal and is more safe than dilatation and curettage. It is invaluable in achieving a cure for these patients without resorting to more aggressive surgery. Blind dilatation and curettage is diagnostically inaccurate and often ineffective as it may miss the focal endometrial lesions. After removal of bony fragments, restoration of fertility and improvements of symptoms is expected. Ultrasound and hysteroscopy are both complementary and when used in conjunction can increase the number of cases diagnosed.

Keywords: Abnormal uterine bleeding, retained intrauterine fetal bone chips, transvaginal ultrasound, hysteroscopy.