A 28-year-old primigravida at 22 weeks gestation with a known 8 cm intramural fibroid presents with acute onset of severe localized pain over the uterus, low-grade fever (99.4°F), and tenderness localized to the fundal region. There is no peritoneal guarding. White cell count is 12,500/cumm. What is the MOST likely diagnosis and appropriate management?
- A Torsion of fibroid; emergency laparotomy with myomectomy
- B Red degeneration of fibroid; conservative management with NSAIDs and rest ✓
- C Sarcomatous change; urgent hysterectomy
- D Placental abruption; emergency caesarean section
Correct answer: B. Red degeneration of fibroid; conservative management with NSAIDs and rest
Explanation
Red degeneration of a uterine fibroid in pregnancy classically presents in the second trimester with acute localized pain, low-grade fever, and focal tenderness, caused by haemorrhagic infarction of the fibroid. Management is conservative with acetaminophen, NSAIDs, and rest, as the condition self-resolves. Myomectomy is avoided during pregnancy due to high haemorrhage risk. Sarcomatous change is rare and presents with rapid growth, not acute pain with fever.
Reference: High Risk Pregnancy: Management Options, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.