Identification and treatment of intra-abdominal fetal skeletal remains: A consequence of illicit and unsafe abortion

Abstract

Objective The safety of abortions has always been a matter of concern for women's health. Unsafe abortion is one of the most neglected health-care problems in developing countries due to lack of awareness of the legal issues and limited access to authorised services often leading the women to poor quality of abortion in unsafe settings through untrained health personnel.

Case report Two rare cases of second trimester unsafe abortions are reported here in which women presented after several weeks with well-preserved remains of fetal skeleton in their abdomen along with complicated multiple visceral injuries. Both these second trimester abortions were performed by untrained village abortionists for sex selection and unwanted pregnancy in an unmarried adolescent girl. The management in the unmarried girl was further complicated due to undisclosed history of abortion.

Conclusion These reports of unsafe abortion highlight the need for clinicians to have a high index of suspicion for an undisclosed abortion when treating any morbid woman of reproductive age with a bizarre abdominal clinical picture.

Chinese Abstract

摘要：

目的： 人工流产的安全性一直是女性健康关注的问题。不安全流产是发展中国家最容易被忽视的健康问题之一，因为这些国家的女性缺乏法律意识、授权服务受限，流产设备安全性差，卫生人员未经训练，最终导致女性流产质量低劣。

病例报告：文中报道了孕中期不安全流产的两个罕见病例，这两名女性在流产后几周腹部还有保存完好的胎儿骨骼，且并发多脏器损伤。这两个孕中期妊娠流产均由未经训练的乡村堕胎者实施，一例是因为性别选择，一例是未婚青春期少女的意外妊娠。由于隐瞒流产病史，未婚女性的处理更加复杂。

结论：这些不安全流产的报告强调指出：临床医生面对任何一个具有奇怪的腹部临床图像的育龄期女性时，都要都要高度怀疑是否隐瞒流产史。

Keywords:

• Unsafe abortion
• Uterine perforation
• Fetal skeleton
• Gut perforation

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.