Fibroids, Red degeneration

Dilemma

Step 1: View clinicals

A 28 year old lady who is 26 weeks pregnant presents with severe right sided abdominal pain for 1 day associated with nausea and vomiting. This is her first pregnancy. Her medical and gynecological histories are unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 13,400/mm3 N: 75% L: 20% Hb: 12.9 g/dl Hct (PCV): 38% Platelets: 336,000/mm3

Urinalysis

Pus cells: 1 - 2 /hpf RBC: nil/hpf pH: 5.5 Nitrite dipstick test: negative

Cardiotocogram

The cardiotocogram shows a fetal heart rate within normal parameters. There is no evidence of uterine contractions.

Abdominal + Pelvic Ultrasound

A 6cm x 6cm echogenic mass is noted in the anterior wall of the uterus, corresponding to the area of abdominal tenderness. No urinary calculi are noted, while the appendix is not visualized. Both ovaries appear normal, with satisfactory blood flow.


Step 3: Select appropriate management

Analgesics
Antibiotics
Urgent cesarian section
Myomectomy


Score: ★★☆