A 28-year-old primigravida at 20 weeks gestation presents with acute onset localized abdominal pain, low-grade fever, and tenderness over a known uterine fibroid. Ultrasound shows a single 8 cm intramural fibroid with no evidence of torsion. Which is the most appropriate management?
- A Conservative management with analgesics, intravenous fluids, and rest ✓
- B Emergency myomectomy under general anesthesia
- C Induction of labor followed by myomectomy
- D Hysterectomy after fetal evacuation
Correct answer: A. Conservative management with analgesics, intravenous fluids, and rest
Explanation
This is red degeneration of a uterine fibroid in pregnancy, caused by hemorrhagic infarction due to rapid fibroid growth outstripping its blood supply. Management is conservative with analgesics, hydration, and rest, as most cases resolve within 7 to 10 days. Myomectomy in pregnancy is avoided due to high risk of hemorrhage and pregnancy loss, and is reserved only for complications such as torsion or refractory pain.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.