A Successful Pregnancy Despite the Presence of an Intrauterine Fetal Bone Fragment

Abstract

Objective Intrauterine retention of fetal bones following a termination of a pregnancy is a rare complication. Among the few reported cases in literature, there has been no report describing the birth of a live fetus, despite the presence of an embryonic ossicle within the endometrial cavity. Case Report A 28-year-old woman, with an obstetrical history of a miscarriage at the 19th week of gestation, underwent a diagnostic hysteroscopy for evaluation of pelvic pain and infertility, which revealed an intrauterine embryonic ossicle. The patient did not comply with our recommendations to undergo a surgical hysteroscopy. The patient's next visit was during her 9th week of gestation. She was followed up regularly at our Obstetrics Department. Her gestation was uneventful, while an elective caesarean section at the 39th week of gestation was performed. Conclusion The present clinical case has demonstrated that achieving childbearing is possible, despite the requirement of removing such bone fragments.

Secondary Infertility due to Fetal Bone Retention

“…34 As seen from the outcomes of case reports by Danjani et al, Moon fetus had preceded secondary infertility and the removal of retained fetal bones, most commonly via hysteroscopy allowed these patients to conceive. 6,16,24,25,30,31,32,34,35,36 In our study, the hysteroscopic removal was performed in 69%, allowing 59% of patients to conceive after the procedure. Other treatment methods used include D&C without hysteroscopy in 23% and dilation and evacuation 4% of patients.…”

“…Interestingly, however, Petrakis et al ( 2019) also reports the case of a successful live pregnancy, conceived spontaneously, and carried to term, in a patient with calcium salt deposits in the placenta and the intrauterine retention of fetal bone from a previous miscarriage at 19 weeks gestation a year ago. 24 To date, this is the only reported case where a patient could conceive despite the presence of intrauterine fetal bones.…”

“…There was one case (1%) in which a patient conceived despite the presence of intrauterine bone fragments. 24 In comparison, 18 (24%) did not conceive at the time of the study. In the remaining twelve patients (16%), either they were not followed up for infertility, had other outcomes, or details of follow-up are unknown.…”

“…The shortest interval seen was 12 months, and the longest was 180 months. 24,25 In a study by Petrakis et al, a patient presented with chronic pelvic pain and infertility 12 months after a miscarriage at 19 weeks gestation due to placental abruption. 24…”

Retained Intrauterine Fetal Bone Fragments Causing Secondary Infertility: A Review

“…These fragments may cause persistent inflammation and scarring within the uterine cavity, disrupting the delicate balance necessary for successful implantation and pregnancy. Consequently, couples affected by this condition may experience difficulty achieving a subsequent pregnancy, leading to secondary infertility [ 8 ]. Moreover, retained fetal bone fragments can also contribute to recurrent miscarriages, as they interfere with the normal development of a healthy pregnancy.…”