A 38-year-old woman with a 6 cm posterior intramural fibroid and recurrent pregnancy loss (3 consecutive first-trimester miscarriages) with no other identified cause. Her uterine cavity is not distorted on hysteroscopy. What is the MOST evidence-based management for the fibroid?
- A Myomectomy — fibroid resection improves live birth rates in recurrent miscarriage
- B Expectant management — intramural fibroids not distorting the cavity do not affect pregnancy outcome ✓
- C Uterine artery embolization before attempting further pregnancy
- D GnRH agonist pre-treatment for 3 months then attempt spontaneous conception
Correct answer: B. Expectant management — intramural fibroids not distorting the cavity do not affect pregnancy outcome
Explanation
Current evidence (RCOG Green-top, ESHRE recurrent pregnancy loss guideline 2023) does not demonstrate that intramural fibroids not distorting the uterine cavity cause recurrent miscarriage, and myomectomy has not been shown to improve live birth rates for this phenotype. Submucous or cavity-distorting fibroids do require resection. UAE is not recommended before pregnancy due to risk of uterine ischaemia and miscarriage. GnRH agonists shrink fibroids temporarily without addressing underlying cause.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.