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Delayed miscarriage inside an infected decidual cast: a rare complication of the Depo medroxyprogesterone acetate injection
  1. Ryo Fukaura,
  2. Alistair Ward and
  3. Shreelata Datta
  1. Obstetrics and Gynaecology, East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
  1. Correspondence to Dr Ryo Fukaura; r.fukaura{at}


Decidualisation of the endometrium is a progesterone-mediated reaction that naturally occurs during a woman’s menstrual cycle. The hyperproliferated tissue is then usually dissolved and passed in a menstrual period. Occasionally, the natural dissolution does not happen, and the tissue maintains the shape of the endometrium, forming a decidual cast. These casts are known to be formed secondary to the use and/or cessation of various contraceptive methods. Here, we report a case of a patient presenting with passage of a decidual cast secondary to cessation of the Depo medroxyprogesterone acetate injection. This is the first reported case of the cast becoming infected, and also the first case of a decidual cast containing old products of conception.

  • contraception
  • pregnancy
  • obstetrics and gynaecology

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  • Contributors All authors were involved in the clinical care of the patient during her period of admission in hospital. RF took overall responsibility of the work, analysed evidence and investigation results, performed a literature search, initially drafted and revised the report. AW analysed investigation results, performed a literature search, and revised the report. SD analysed investigation results, and revised the report. All authors approved the final version of the report and accept responsibility for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.