Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2012, Article ID 701021, 2 pages doi:10.1155/2012/701021 Case Report First Trimester Abortion: A Rare Cause of Intrauterine Bony Spicules Anshuja Singla, Bindiya Gupta, and Kiran Guleria Department of Obstetrics & Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi 110095, India Correspondence should be addressed to Anshuja Singla, dranshuja@gmail.com Received 9 March 2012; Accepted 23 May 2012 Academic Editors: A. Awonuga, H.-C. Lai, and K. Takeuchi Copyright © 2012 Anshuja Singla et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following ﬁrst trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal. 1. Case Report A 23-year-old woman presented with complaints of sec- ondary infertility and postmenstrual spotting for one year. She gave a history of missed abortion of ten-week period of gestation for which she underwent dilatation and curettage for retained products after two months of abortion. Her menstrual cycles were regular with normal ﬂow. General physical and pelvic examination was normal. Transvaginal ultrasonography revealed a linear hyper- echogenic endometrial shadow, suggestive of calciﬁed lesions (Figure 1). Diagnostic hysteroscopy revealed a pale endometrium with white, bone-like, and spicules occupying almost whole of the cavity till the internal os and extending into the posterior uterine wall (Figure 2). The cervix was dilated, and the bony spicules were removed from the uterine cavity by curettage (Figure 3). Histopathologic examination conﬁrmed multiple bony pieces suggestive of retained prod- uct of conception. Following this report, the history was reviewed again in which the patient confessed of having a premarital second trimester medical termination of pregnancy three years back. Three weeks after surgery although the patient had a normal menstrual period, ultrasound showed persistence of calciﬁ- cations. She was posted for a repeat hysteroscopic removal of bony spicules. This time her evacuation was complete, and her follow-up scan after two weeks was normal. On followup, the patient’s hormonal proﬁle and her husband’s semen analysis are within normal limits, and she has been advised a hysterosalpingogram for tubal patency. 2. Discussion Majority of cases of endometrial ossiﬁcation present with secondary infertility after second trimester abortions but symptoms of menometrorrhagia, dysmenorrhea, vaginal dis- charge, pelvic pain, and spontaneous expulsion of bony fragments in the menses can also be seen in some [1]. In this case, the patient had a history of both ﬁrst and second trimesters termination of pregnancy. The former seems to be a more probable cause for bony fragments in the present case, as the patient had conceived following the second trimester termination. First trimester abortions are an unusual cause of fetal bones. Occasionally dystrophic calciﬁcation and ossiﬁcation of retained fetal tissue may result in bone formation [2]. Besides this, osseous metaplasia of mature endometrial stromal cells due to prolonged chronic inﬂammation and tissue de- struction can also result in heterotopic bone formation in the uterus [3]. Our patient presented both with menstrual complaints and infertility. Endometrial ossiﬁcation may cause secondary infertility by three mechanisms: (1) prevention of implantation as a result of obliteration of the uterine cavity (mechanical