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Case Reports in Obstetrics and Gynecology
Volume 2017, Article ID 6345712, 3 pages
https://doi.org/10.1155/2017/6345712
Case Report

Chronic Pelvic Pain and Infertility Resulting from Unrecognized Retained Laminaria

1American University of the Caribbean, Coral Gables, FL, USA
2Department of Obstetrics and Gynecology, Providence Hospital, Michigan State University College of Human Medicine, East Lansing, MI, USA

Correspondence should be addressed to Wesley Nilsson; moc.liamg@yelsewnosslin

Received 24 April 2017; Accepted 2 August 2017; Published 28 August 2017

Academic Editor: Julio Rosa-e-Silva

Copyright © 2017 Wesley Nilsson 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.

Abstract

Background. In 2013, the abortion rate in the United States was found to be 200 abortions per 1,000 live births. Of these, the CDC estimates that nearly 49% were performed using unsafe measures. Even when these procedures are safely performed, patients are at risk for immediate or delayed complications. In second-trimester terminations, mechanical dilation with an osmotic dilator is common to allow for delivery of the fetus. The Japanese seaweed Laminaria japonica is used to achieve this purpose. Case. A 28-year-old primigravida presented with chronic pelvic pain and infertility. She had irregular menstrual cycles and reported scant yellow discharge. A transvaginal ultrasound revealed an abnormally appearing endometrium with an elongated structure suspicious for a foreign body. The patient reported a voluntary termination of pregnancy twelve years earlier, for which laminaria were placed prior to the dilation and extraction. She underwent an operative hysteroscopy confirming our suspicion for retained laminaria. The pathology report demonstrated chronic severe endometritis and plant based material. Conclusion. Retained laminaria are associated with chronic pelvic pain and chronic infertility. Since they can be difficult to detect on conventional imaging, proper counting prior to insertion and after removal is an essential physician responsibility.