A 26-year-old primigravida at 16 weeks gestation presents with sudden lower abdominal pain and low-grade fever of one day duration. She has a known anterior wall fibroid of 6 cm. On examination she is afebrile at 37.8 degrees C, the fibroid is markedly tender, and WBC count is 14,000/mm3. Fetal heartbeat is normal. The MOST appropriate next step is:

• A Immediate myomectomy
• B Uterine artery embolization
• C Conservative management with analgesics and hydration ✓
• D Emergency hysterectomy

Explanation

This is red (carneous) degeneration of a fibroid, classically seen in the second trimester. Venous thrombosis within the tumour causes necrosis, severe localized pain, low-grade fever and leukocytosis. It is self-limiting and managed conservatively with rest, hydration and NSAIDs (paracetamol preferred in pregnancy), with resolution in days to weeks. Surgery is reserved only if torsion or an uncertain diagnosis cannot be excluded. Myomectomy in pregnancy carries a high risk of haemorrhage and is avoided.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.