28 weeks pregnancy with abdominal pain and fever. Ultrasonographic examination shows presence of fibroid. What is the next line of management-
Ans. is 'b' i.e., Conservative management o The presence ofpain and fever in a female in her mid pregnancy with ultrasound examination showing presence offibroid supports the diagnosis of red degeneration.Red Degeneration (Also known as Carneous Degeneration)o Occurs in pregnant females with presence of fibroid because fibroid overgrows its blood supply (micronecrothrombosis).o Most commonly occurs in second trimester of pregnancy followed by in the puerperium.o Cut section : raw beefy appearance, fishy odor.o Patient presents with acute abdomen, vomiting, fever, and leukocytosis,o D/D : acute appendicitis, pyelonephritis, and abruption.Management:o Always conservative management (never surgery)o Hospitalizationo Bed resto Analgesicso IVfluidso IV antibiotics (SOS)Some important points about fibroidso Most common degeneration overall-Hyalineo Most common degeneration in pregnancy-Redo Cystic degeneration is most common in-Post menopausal wromen & interstitial fibroido Calcareous degeneration is most common in-Subserous fibroido Most common fibroid to undergo torsion-Subserous fibroid.o Pseudo Meigh syndrome is associated with-Subserous fibroid.o Wandering or parasitic fibroid-Subserous fibroid.o Most common type of fibroid-Intramural / interstitial.o Fibroid with maximum symptoms-Submucous.o Most symptomatic fibroid-Submucous,o Most common fibroid to undergo malignant change-Submucous.o Lantern on dome of St paul-Cervical fibroid.o Most common to cause urinary retention-Posterior cervical.o Most common menstrual symptom-Menorrhagea.o Inversion is associated with-Fundal fibroid.
Hysterectomy
Conservative management
Termination
Myomectomy
Treatment and Recurrence