Dilemma

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.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 13,400/mm3
N: 75% L: 20%

Hb: 12.9 g/dl
Hct (PCV): 38%

Platelets: 336,000/mm3
Urinalysis

Performed

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

Performed

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

Performed

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.

Select Relevant Management
Analgesics
Antibiotics
Urgent cesarian section
Myomectomy