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FOCUSED SHIFT VIEW

Acute Pelvic Pain (Women)

Pregnancy status first — then torsion, then the rest.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Pregnancy test first. Unstable with suspected ruptured ectopic: resuscitate and involve obstetrics for surgery; bedside US must not delay care.
  2. Then torsion: sudden unilateral pain — Doppler is supportive, not exclusive.
  3. Transvaginal US is the workhorse; CT when US is non-diagnostic and pregnancy is excluded.

2 · Escalate now if

  • Positive hCG with pain or bleeding — ectopic until excluded
  • Hypotension, syncope, or peritoneal signs
  • Sudden severe unilateral pain (torsion)
  • Fever with adnexal tenderness (TOA)
  • IUD in situ with pain or pregnancy
  • Bleeding at any stage of pregnancy

3 · Immediate workup

  • Urine/serum hCG immediately
  • POCUS then transvaginal US — the definitive study

4 · Don’t miss

  • Ruptured ectopic pregnancy
    hCG first in every patient of childbearing potential; unstable = operating room, not imaging.
  • Ovarian torsion
    Sudden severe unilateral pain ± mass; Doppler US — delay loses the ovary.
  • Tubo-ovarian abscess
    PID with mass or sepsis — admission, IV antibiotics, drainage per response.
  • Hemorrhagic ruptured ovarian cyst
    Sudden pain with free fluid; watch hemodynamics, especially anticoagulated.
  • Septic abortion / puerperal infection
    Fever + bleeding + uterine tenderness in pregnancy or postpartum.

5 · Disposition lane

Admit

PID/TOA on IV antibiotics, medically-managed ectopic per criteria, hemorrhagic cyst under observation, uncontrolled pain.

Emergency surgery / IR

Ruptured ectopic, ovarian torsion, ruptured TOA, unstable hemorrhagic cyst.