March 23rd, 2018

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Unusual Complication of Second Trimester Termination: Embedded Fetal Spine: A Case Report
Authors:  Adam V. Levy, M.D., Neetu Cheema, M.D., and Vani Dandolu, M.D.
BACKGROUND: Loss of fetal parts during second trimester pregnancy termination is unusual and, when noted, needs thorough and systematic evaluation to avoid serious morbidity.

CASE: A young woman who had undergone D&E pregnancy termination at 19 weeks’ gestation at a local family planning clinic was referred to the University Hospital when it was noted that the fetal spine was unaccounted for and could not be located. The fetal spine was found to have penetrated into the cervical stroma. Stepwise evaluation and recovery of the fetal spine is described. Notably, cervical preparation for the D&E had been done with misoprostol alone.

CONCLUSION: In cases where loss of fetal part(s) is detected, prompt evaluation and recovery of the fetal part(s) are crucial. To prevent complications such as this, we suggest that additional cervical preparation with osmotic dilators may be superior to the use of misoprostol alone.
Keywords:  abortion, induced; abortion, legal; abortion on demand; abortion techniques; pregnancy; retained fetus
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