A 26-year-old primigravida at 20 weeks gestation presents with acute onset severe lower abdominal pain, low-grade fever and vomiting. Examination shows a 10 cm firm uterine fundal mass that is exquisitely tender. Ultrasound confirms a solid well-defined mass continuous with the uterus. Leukocyte count is mildly raised. What is the BEST initial management?
- A Conservative management with analgesia and hydration ✓
- B Immediate myomectomy
- C Emergency hysterotomy and enucleation of the mass
- D Uterine artery embolisation
Correct answer: A. Conservative management with analgesia and hydration
Explanation
Red (carneous) degeneration of a fibroid in pregnancy presents with acute localised pain, tenderness, mild fever and leukocytosis, typically in the second trimester. It is self-limiting over days to weeks and managed conservatively with rest, hydration and simple analgesia. Myomectomy during pregnancy risks haemorrhage and miscarriage, embolisation is contraindicated in pregnancy, and hysterotomy is never indicated for this condition.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.