A 34-year-old woman at 22 weeks of pregnancy presents with acute onset of severe localized abdominal pain, low-grade fever, and tenderness over a known 8 cm uterine fibroid. Ultrasound shows a heterogeneous fibroid with absent internal vascularity. What is the most likely diagnosis and appropriate management?

• A Torsion of fibroid; emergency myomectomy
• B Red degeneration; conservative management with analgesics ✓
• C Sarcomatous change; urgent hysterectomy
• D Degeneration with infection; broad-spectrum antibiotics

Explanation

Red degeneration of a uterine fibroid in pregnancy presents with acute localized pain, low-grade fever, and tenderness, caused by hemorrhagic infarction of the fibroid. Ultrasound shows heterogeneous echotexture. Management is conservative with analgesics, as the condition is self-limiting. Surgery is avoided in pregnancy unless complications such as torsion or refractory pain occur.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.