The incidence of retained fetal bones after 1,002 hysteroscopies in an environment with restrictive abortion laws

Background: Retained fetal bones within the uterine cavity are rare. The incidence in an environment with restrictive abortion laws is however unknown. Aim: To document the incidence of retained fetal bones in an environment with highly restrictive abortion laws. Methods: Case records of patients who had hysteroscopy on account of retained fetal bones from April 1, 2010 to March 31, 2017 were retrieved. Data including age, number of terminations of pregnancy, gestational age at termination of pregnancy, duration of infertility, and treatment outcome were retrieved. Results: A total of 1,002 patients had hysteroscopy for various indications. Of these, 26 patients had retained fetal bones giving an incidence of 0.26%. The age range of the patients was 28--42 years, mean 34.7 ± 4.6 SD. Duration of infertility ranged from 2 to 8 years, mean 4.6 ± 2.3 SD. The number of terminations of pregnancy ranged from 1 to 6, mean 2.6 ± 1.7 SD. One patient had an unexplained intrauterine fetal death of one of a set of twins at 20 weeks gestation with subsequent elective cesarean section at 37 weeks gestation. All the cases had histological confirmation of fetal bones. Of the 24 patients who had secondary infertility, 6 (25.0%) achieved spontaneous pregnancies. Eight women underwent in vitro fertilization treatment with 2 (25%) clinical pregnancies. Conclusion: The incidence of intrauterine retained fetal bones in our environment with highly restrictive abortion laws is 0.26%. A review of these laws is probably long overdue.