Ans. is c, i.e. Red degeneration of fibroidRef: Shaw 15th/ed p355; Dutta Ohs 6th/ed p314; High Risk Pregnancy 2nd/ed p77The answer is quite obvious but let's see how other options can be ruled out.Option "a" Preterm laborPoints in favorPoints against* Patient is pregnant* Pain in abdomen at 28 weeks (preterm labor is where labor starts before the 37th completed weeks. The lower limit is 28 weeks in developing countries and 20 weeks in developed countries* Preterm labor is diagnosed- When there are regular uterine contractions. (Not acute pain) With or without pain at least in every 10 minutes.- Dilatation of cervix is >2cm- Effacement of cervix =80%- Length of cervix as measured by TVS <2.5cm and funneling of the internal OS.- Pelvic pressure backache, vaginal discharge, or bleeding. None of the above criteria are being fulfilled* Presence of leukocytosis and fever can also go against it as even if there is intra-amniotic infection causing preterm labor features like--fever, leukocytosis, uterine tenderness, and fetal tachycardia are absent. Rather, if these features are present it means a final stage of uterine infection has reached. And here our patient is having fever, leukocytosis without regular uterine contractions (off and on pair) but with acute pain in abdomen, so it can be ruled outOption "b" Torsion of fibroidPoints in favorPoints against* Patient has fibroid (Though no mention has been made whether it is pedunculated or not, Remember torsion is seen in subserous pedunculated myomas)Q* Patient is complaining of acute pain in abdomen* Torsion is not associated with fever and leukocytosisOption "d" Infection of fibroidPoints in favorPoints against* Presence of fibroid (Remember. Infection is common in submucous fibroids)Q* Fever* Leukocytosis* Acute pain in abdomen (Infection of fibroid will not cause acute pain in abdomen).* Infection of fibroid occurs following abortion or labor (Here patient is pregnant but there is no history of abortion or labor)* Infection causes blood stained discharge (Not seen in this patient)So, from above discussion infection can be kept in +- status. If we have no better option, we can think about it.Option "c" i.e. Red degeneration of fibroid is the diagnosis-let's have a look.Red degeneration of fibroid* It is seen mostly during pregnancy and mid pregnancyQ* The myoma suddenly becomes acutely painfulQ, enlarged,Q and tender.Q* Patient presents with:- Acute abdominal painQ- VomitingQ- MalaiseQ- Slight feverQLab investigations: Show moderate leukocytosisQ and raised ESRQThus, all the features given in the question favor the diagnosis of red degeneration.