Chapter 14 – Acute Pelvic Pain and Other Gynaecological Emergencies

Summary of chapter

Gynaecological emergencies may present with acute severe pelvic pain or heavy vaginal bleeding, and may be associated with hypovolaemic or septic shock. Causes can include ectopic pregnancy, miscarriage, acute pelvic inflammatory disease (PID), tubo-ovarian abscess, post-partum sepsis or haemorrhage, or post-operative infection or haemorrhage.(1) The key points in management are to ensure hemodynamic stability, instituting emergency resuscitation measures where indicated and to rapidly distinguish between pregnancy-related causes, gynaecological disorders and non-reproductive tract causes. It is important to remember that early pregnancy complications and loss not only represent potential medical emergencies but may also be very distressing for a patient and their partner.


All women of reproductive age presenting with pelvic pain and/or vaginal bleeding should be assumed to be pregnant until proven otherwise.

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