RESUMO
To provide a comprehensive review of the published literature of patients with endo- metrial bone or osseous fragments with a view to critically examine the antecedent clinical presentation, investigations and prognosis after treatment. This systematic review of the literature includes full text articles of published case re- ports and cases series from the following computerized databases: PubMed, Ovid, and Medline between 1928 and 2013. We reviewed a total of 293 patients in 155 case reports and case series. The mean +/- SD age at presentation was 32.7 +/- 8.9. Approximately 88% of patients had at least one prior surgical uterine evacuation relating to pregnancy termina- tion or loss at a median gestational age of 14 weeks [range of 4-41 weeks]. The most common presenting symptom was infertility [56.2%]. One hundred twenty- four [66.0%] of the 188 patients attempting pregnancy after treatment achieved pregnancy prior to article publication and the majority [82.3%] were spontane- ous. Spontaneous miscarriage rate remains high [43%]; however, most pregnancies ended in live-birth [55%]. Bone fragments in the endometrium are most commonly found after pregnancy termina- tion, present with infertility and/or irregular menses, and upon removal, patients rapidly conceive spontaneously