title: Secondary infertility as a late complication of vesico-amniotic shunt therapy.
abstract: OBJECTIVE
  Vesico-amniotic shunting can be used for the treatment of fetal obstructive uropathy. However, the procedure is associated with a significant risk of complications. We report a case of a complicated vesico-amniotic placement, where a vesico-amniotic shunt ultimately resulted in, fortunately reversible, infertility.
  
  
  METHODS
  A 36-year-old multigravida was referred to our center at 13 weeks' gestation for the evaluation of fetal lower urinary obstruction. A vesico-amniotic shunt placement requiring several attempts was performed. A few weeks later premature rupture of the membranes occurred. At the request of the parents, the pregnancy was terminated at 22 weeks'gestation. The patient visited us again for secondary infertility, which turned out to be caused by a shunt left behind in the uterus, acting as an IUD. After hysteroscopic removal, she soon became pregnant again.
  
  
  CONCLUSIONS
  This case illustrates the importance of careful documentation relating to each and every operation, of all materials used and what was retained in the patient. At delivery, obstetric staff should be completely aware of the prenatal treatment procedures performed, to ensure that no foreign objects are left by oversight, inside the patient's body.
authors.affiliation: Department of Obstetrics and Gynaecology, Bronovo Hospital, The Haque, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Kamphuis
authors.forename: F
authors.initials: F
authors.lastname: Lim
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000025:Abortion, Eugenic; D000650:Amnion; D000714:Anastomosis, Surgical; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014524:Urethral Obstruction / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014599:Uterus / Q000000981:diagnostic imaging