Retained Bones of the Second Twin Following a Cesarean Section: A Case Report
Twin pregnancies are increasing due to assisted reproductive techniques. Following the death of one twin in-utero, the surviving and dead twin are removed from the uterine cavity at delivery. This is a report of a 38-year-old para 0+3 woman who experienced fetal demise of one of a set of twins at 20 weeks of gestation. She had an elective cesarean section during which the dead twin was forgotten in the uterine cavity. She presented with profuse vaginal discharge that was sterile on culture. An ultrasound scan showed the presence of several echogenic substances within the endometrial cavity. These substances were hysteroscopically removed and confirmed by histology to be fetal bones. The vaginal discharge subsequently stopped. In conclusion, uterine revision should always be performed during cesarean section to prevent such an occurrence.
Keywords: cesarean; fetal bones; hysteroscopy; retention; twin.
Conflict of interest statement
The author declares no conflicts of interest in this work.
- Okohue JE, Onuh SO, Ikimalo JI, Wada I. Patients’ preference for number of embryos transferred during IVF/ICSI: a Nigerian experience. Nig J Clin Pract. 2010;13(3):294–297. –PubMed
- Chelli D, Methni A, Boudaya F, Marzouki Y, Zouaoui B, Jabnoun S. Twin pregnancy with single fetal death: etiology, management and outcome. J Gynecol Obstet Biol Reprod. 2009;38(7):580–587. doi:10.1016/j.jgyn.2009.09.004 – DOI – PubMed
- Grigore M, Pristavu A, Gafitanu D. Ultrasound features of osseous metaplasia of the endometrium – case series and review of the literature. Clin Imaging. 2018;52:260–263. doi:10.1016/j.clinimag.2018.08.006 – DOI – PubMed
- Woo HH, Sin SY, Tang LC. Single foetal death in twin pregnancies: review of maternal and neonatal outcomes and management. Hong Kong Med J. 2000;6(3):293–300. – PubMed
- Pharoah PO, Adi Y. Consequences of in-utero death in a twin pregnancy. Lancet. 2000;355(9215):1597–1602. doi:10.1016/S0140-6736(05)72455-7 – DOI – PubMed
- Lanzarone VF, Pardey JM. Retained intrauterine fetal bone as a rare cause of secondary infertility. Aust N Z J Obstet Gynaecol. 2009;49(6):700–701. doi:10.1111/j.1479-828X.2009.01072.x – DOI – PubMed
- Ikechebelu JI, Eleje GU, Eke NO. Hysteroscopic removal of retained intrauterine fetal bone causing chronic pelvic pain. Niger J Surg Sci. 2017;27(1):30–32. doi:10.4103/njss.njss_24_13 – DOI
- Eke AC, Denny M, Roth S, Martin D, Buras A, Woo J. Intrauterine cleaning after placental delivery at cesarean section: a randomized controlled trial. J Matern Fetal Neonatal Med. 2019;32(2):236–242. doi:10.1080/14767058.2017.1381904 – DOI – PMC – PubMed
- Chukwuneke FN. Medical incidents in developing countries: a few case studies from Nigeria. Nig. J Surg Pract. 2015;18(7):20–24. doi:10.4103/1119-3077.170821 – DOI – PubMed
- Gainders S, Arora P, Dhaliwal LK. Retained intrauterine bone fragments as a cause of secondary infertility in a tertiary level Indian hospital. J Hum Reprod Sci. 2018;11(3):286–290. doi:10.4103/jhrs.JHRS_33_18 – DOI – PMC – PubMed
- Elford K, Claman P. Novel treatment of a patient with secondary infertility due to retained fetal bone. Fertil Steril. 2003;79(4):1028–1030. doi:10.1016/s0015-0282(02)04815-x – DOI – PubMed