ODOBGYNDECODED

← All presentations

Acute pelvic pain (non-pregnant)

Bleeding in pregnancyAbdominal pain in pregnancyReduced fetal movementsHeadache + high BP in pregnancy/postpartumFever in pregnancy/postpartumDyspnoea in pregnancyVaginal discharge / cervicitisAcute pelvic pain (non-pregnant)Postmenopausal bleedingInfertility evaluation
Immediate red flags:
  • Peritonism
  • Adnexal mass+vomiting (torsion)
  • Positive hCG ANY context
  • TOA signs
Urgent workup:
  • Urine hCG mandatory
  • TVS pelvis
  • CBC/CRP; STI NAATs

Structured differential — act in priority order

PriorityConditionKey featuresAction
CANNOT MISS
Ovarian torsion
Acute+vomiting+mass
Emergency laparoscopy detorsion →
CANNOT MISS
Ectopic pregnancy
hCG+
Ectopic pathway →
COMMON
PID/TOA
Discharge+cervical motion tenderness
PID regimens ± drainage →
COMMON
Ruptured cyst
Mid-cycle, free fluid
Conservative if stable
COMMON
Appendicitis
GI migration pattern
Surgical assessment
CONSIDER
Endometriosis flare
Dysmenorrhoeic history
Endo module →

First moves

  1. Torsion and ectopic outrank all other diagnoses until excluded