A 28-year-old nulliparous woman with a 4 cm FIGO Type 0 submucosal fibroid presents with menorrhagia (PBAC score 210) and primary infertility for 2 years. Hysterosalpingography confirms bilateral tubal patency. Semen analysis is normal. Which is the most appropriate management to address both her bleeding and fertility?

• A Total abdominal hysterectomy with ovarian conservation
• B Uterine artery embolisation
• C Hysteroscopic myomectomy ✓
• D Laparoscopic myomectomy

Explanation

FIGO Type 0 submucosal fibroids are entirely within the uterine cavity and are best removed hysteroscopically. Submucosal fibroids impair fertility by distorting the cavity and interfering with implantation; hysteroscopic myomectomy improves both bleeding and conception rates. UAE is contraindicated when fertility is desired. Laparoscopic myomectomy is suited for intramural or subserosal fibroids, not intracavitary ones.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.