Gynaecological emergencies and acute pelvic pain

• Acute pelvic pain in a woman of reproductive age is an emergency until a dangerous cause is excluded: an ectopic pregnancy, a twisted ovary, pelvic sepsis, or a ruptured cyst with bleeding.
• The first bedside test is a pregnancy test, done before any imaging, because pregnancy status changes the whole differential and the safest imaging pathway.
• The commonest gynaecological causes are pelvic inflammatory disease (PID), ruptured or haemorrhagic ovarian cysts, ovarian torsion, ectopic pregnancy, and (in pregnancy) miscarriage-related pain. Non-gynaecological causes such as appendicitis and renal stones sit in the same differential.
• Transvaginal ultrasound is the first-line imaging test once pregnancy is excluded or is clinically stable; CT and MRI have specific second-line roles.
• The decision to operate is driven by haemodynamic instability, peritonism, a suspected ruptured ectopic pregnancy, torsion, tubo-ovarian abscess with sepsis, or a diagnosis that cannot be excluded without direct inspection.

By the end of this page you should be able to:

1. Explain why a pregnancy test is the first investigation in any woman of reproductive age with acute pelvic pain, and state the safety-critical pitfalls of a negative result.
2. List the red flags of acute pelvic pain and the immediate resuscitation steps.
3. Give a prioritised differential diagnosis, organised by urgency, and the single feature that best separates each condition.
4. Describe how ectopic pregnancy is diagnosed and stratified for expectant, medical (methotrexate) or surgical treatment using the thresholds in current guidelines.
5. Recognise ovarian torsion and state why time is tissue, even when Doppler flow is present.
6. Choose initial imaging and describe the outpatient and inpatient antibiotic regimens for PID, with dosing and follow-up.
7. State when to operate and when referral or transfer is required.

Pelvic pain is one of the commonest presentations to gynaecology and emergency departments, and its most dangerous causes are easy to miss because they can present with only vague, one-sided lower abdominal discomfort. Haemorrhagic cysts, PID and ectopic pregnancy share nausea, vomiting, vaginal bleeding and localised tenderness; an infected patient can look surprisingly well early on. The cost of a missed diagnosis is high: ruptured ectopic pregnancy still causes maternal deaths, and torsion can cost an ovary that would have been salvageable 30 minutes earlier.

This page treats the topic as a clinical pathway: stabilise, test, narrow the differential, image, then treat. It compares the major guidelines that bear on it: NICE (NG126), ACOG, RCOG (Green-top No. 21) and WSES, and notes where they disagree rather than smoothing the differences over.

Acute pelvic pain is managed first as a potential surgical abdomen and a potential haemorrhage, before any cause is named.

Red flags that push the patient straight to resuscitation and senior review:

• Sudden, severe, unilateral pain, with syncope or collapse: think ruptured ectopic pregnancy or ruptured haemorrhagic cyst.
• Pain that wakes the patient, with rigid abdomen, rebound or guarding: think peritonitis from any cause (perforated viscus, ruptured abscess, PID with sepsis).
• Shoulder-tip pain or neck/shoulder pain on lying: irritation of the diaphragm by blood (ectopic haemoperitoneum, ruptured cyst).
• Tachycardia (more than 100 beats per minute) or hypotension (less than 100/60 mmHg) in a woman of reproductive age: treat as haemorrhage until proven otherwise.
• Fever over 38.5 C with lower abdominal tenderness, especially post-procedure or with an intrauterine device (IUD): think sepsis/PID or post-operative pelvic infection. ^[5]
• Pregnancy with vaginal bleeding and pain: think miscarriage, ectopic pregnancy or (later) placental causes.

Immediate actions for any haemodynamically unstable patient:

1. Establish intravenous (IV) access with two wide-bore cannulae and start crystalloid resuscitation.
2. Analgesia tailored to severity (paracetamol, then opioids as needed; regional or patient-controlled analgesia if admitted); never let analgesia delay diagnosis, and no evidence suggests it masks the diagnosis.
3. Oxygen, monitoring, blood tests: full blood count, urea and electrolytes, coagulation, blood group and save/hold (crossmatch 4 units if bleeding is likely), C-reactive protein, beta-hCG, progesterone only as part of a structured protocol.
4. Antibiotics when sepsis or PID is plausible, and before source control when it is likely to be incomplete for 6 hours or more: delay in surgical source control of more than 6 hours from sepsis onset worsens outcomes.^[4]
5. Involve the gynaecology, general surgery and critical care teams early; a pregnant uterus or a tubo-ovarian abscess can require joint care.

The single most useful bedside manoeuvre in a shocked woman is still bimanual pelvic examination, performed gently, looking for an adnexal mass, cervical motion tenderness and peritonism. Do not do it if the patient is unstable and operating is imminent; the finding will not change the next step.

In any woman of reproductive age with acute pelvic pain the first question is not "what hurts?" but "could she be pregnant?"^[1] The guidelines are unanimous that pregnancy status is established before imaging and before treatment:

• A pregnancy test (urine or serum beta-hCG) should be offered even when symptoms are non-specific.^[1]
• All healthcare professionals caring for women of reproductive age should have access to pregnancy tests.^[1]
• After excluding pregnancy in a premenopausal woman, the differential narrows and ultrasound becomes the obvious first imaging test, rather than CT.^[6]

A positive test changes almost everything: imaging is ultrasound first, radiation and CT are avoided where possible, a ruptured ectopic becomes the diagnosis to rule out, and medications such as NSAIDs, methotrexate and many antibiotics are used with caution. A negative test is reassuring but not decisive: an ectopic pregnancy in the setting of a negative serum hCG has been documented, albeit rarely, and a ruptured haemorrhagic cyst can present in exactly the same way.^[7] Where suspicion remains high, follow up with hCG and imaging, and retest.

A good history is the most specific diagnostic tool in this setting. Points that matter:

• Menstrual history: date of last period, cycle length, whether this could be an early pregnancy (including irregular cycles); remember that pregnancy can occur with an IUD in place or despite regular bleeding.
• Pain: onset (sudden versus gradual), location, whether it is one-sided, migration (to the right iliac fossa suggests appendicitis), aggravating and relieving factors, relation to intercourse or ovulation.
• Bleeding: amount, clots, tissue passed.
• Vaginal discharge and fever: discharge, dysuria, dyspareunia suggest infection.
• Risk factors for ectopic pregnancy: prior ectopic pregnancy, prior tubal or pelvic surgery, pelvic infection, smoking, assisted conception (IVF), IUD use. About a third of women with an ectopic pregnancy have no known risk factors at all (NICE NG126), so absence of risk factors does not reassure.^[1] A separate US-derived estimate puts the proportion without identifiable risk factors at about half (ACOG Practice Bulletin No. 193).^[2][7]
• Pregnancy and contraception history: including emergency contraception, which can delay or obscure the diagnosis.
• Other abdominal pain causes: bowel, urinary (renal colic, UTI), musculoskeletal, abdominal wall pain.

Abdominal examination comes before pelvic examination. Look for:

• Guarding, rebound and rigidity (peritonitis); localised right-iliac-fossa tenderness with migration suggests appendicitis.
• Distension, absent bowel sounds (paralytic ileus).
• Pallor, sweating, peripheral shutdown (haemorrhage).

Pelvic examination:

• Cervical motion tenderness, uterine tenderness and adnexal tenderness are the three minimum clinical criteria for PID.^[5]
• An adnexal mass, especially moving separately from the ovary ("sliding sign"), suggests ectopic pregnancy or ovarian mass.
• Enlarged, boggy uterus suggests early pregnancy complications or infection.
• Speculum: mucopurulent discharge, friability, blood.

Do not delay resuscitation or imaging to complete a perfect examination in an unstable patient.

The differential is best held in three tiers: what kills today, what costs an organ, and what is painful but not dangerous.

A point the guidelines emphasise repeatedly: other causes of lower abdominal pain are unlikely to be harmed by starting antibiotics for suspected PID when diagnostic uncertainty exists, so overlap treatment is reasonable while the diagnosis is being sorted out.^[5]

Ectopic pregnancy accounts for roughly 2% of all pregnancies in the United States, and ruptured ectopic pregnancy accounted for 2.7% of pregnancy-related deaths from 2011 to 2013, mainly from haemorrhage.^[7] In the United Kingdom the incidence is approximately 11 per 1,000 pregnancies, or about 11,000 per year.^[3] The fallopian tube is the site in about 90% of cases; the cervix, ovary, abdomen and caesarean scar each account for roughly 1-3%.^[7] Half of affected women have no identifiable risk factor (ACOG Practice Bulletin No. 193).^[7]

NICE NG126 divides symptoms into common (abdominal or pelvic pain; amenorrhoea or missed period; vaginal bleeding with or without clots) and other reported (breast tenderness, gastrointestinal symptoms, dizziness, fainting or syncope, shoulder-tip pain, urinary symptoms, passage of tissue, rectal pressure).^[1] About a third of women have no known risk factors.^[1] Signs range from pelvic and adnexal tenderness to pallor, tachycardia over 100 beats per minute, hypotension under 100/60 mmHg, rebound and collapse.^[1]

The diagnosis is clinical first, imaging second. A haemodynamically unstable woman with severe pain and bleeding is referred straight to A&E rather than being processed through an early pregnancy clinic.^[1]

Offer a transvaginal ultrasound scan to women attending an early pregnancy assessment service, to identify the location of the pregnancy and whether there is a fetal pole and heartbeat.^[1] Transabdominal scanning is considered when the uterus is enlarged or pelvic pathology such as fibroids or an ovarian cyst makes a vaginal scan difficult, or when a vaginal scan is unacceptable.^[1]

Ultrasound signs suggesting tubal ectopic pregnancy:^[1]

• An adnexal mass, moving separately from the ovary, comprising a gestational sac containing a yolk sac.
• An adnexal mass, moving separately from the ovary, comprising a gestational sac and fetal pole, with or without a heartbeat.
• Less definite but high-probability signs: a "tubal ring" or "bagel sign" (empty gestational sac, the "sliding sign"), or a complex inhomogeneous adnexal mass moving separately from the ovary.
• Suggestive but not conclusive: an empty uterus, a pseudo-sac (collection of fluid in the cavity), or a moderate-to-large amount of free pelvic fluid suggesting haemoperitoneum.

Serum hCG is used to monitor trophoblastic activity, not to make a diagnosis of location. Do not use a single hCG level, or a "discriminatory zone", to declare an ectopic pregnancy.^[1] In a pregnancy of unknown location:

• Do not use serum hCG to determine the location of pregnancy.^[1]
• Place more importance on clinical symptoms than hCG levels, and review the patient if symptoms change.^[1]
• Take two serum hCG measurements as near as possible to 48 hours apart, using the 63% increase and 50% decrease thresholds: an increase greater than 63% over 48 hours makes a developing intrauterine pregnancy likely; a decrease greater than 50% suggests a failing pregnancy; a decrease less than 50% or an increase less than 63% triggers review within 24 hours.^[1][7]
• Offer an earlier follow-up scan when hCG is at or above 1,500 IU/L.^[1]
• A discriminatory level around 3,500 mIU/mL is sometimes used as the hCG threshold above which an intrauterine pregnancy should be visible on transvaginal ultrasound (ACOG Practice Bulletin No. 193; AAFP), but NICE NG126 advises against using any single hCG level or discriminatory zone to diagnose location; act on symptoms, serial values and imaging instead.^[1][7]

NICE NG126 and RCOG GTG21 agree on the broad structure; NICE provides the clearest thresholds and is reproduced here.^[1][3]

Expectant management is offered to women who are clinically stable and pain free, with a tubal ectopic pregnancy under 35 mm with no visible heartbeat, beta-hCG 1,000 IU/L or less, and able to return for follow-up; it is considered between 1,000 and 1,500 IU/L.^[1] Follow with hCG on days 2, 4 and 7, then weekly until under 20 IU/L, expecting a fall of 15% or more each step. Expectant and medical management appear similar for natural resolution, rupture risk, need for further treatment, and psychological scores, although methotrexate arms may have higher reintervention rates.^[1]

Medical management (systemic methotrexate) is offered to women with no significant pain, an unruptured tubal ectopic pregnancy under 35 mm with no visible heartbeat, beta-hCG under 1,500 IU/L, no intrauterine pregnancy, and reliable follow-up. It should only be offered on the first visit when there is a definitive diagnosis and a viable intrauterine pregnancy has been excluded.^[1] Monitor hCG on days 4 and 7, then weekly until negative; a plateau or rise means reassess.^[1]

Surgery (laparoscopic salpingectomy whenever possible) is first-line for women unable to return for follow-up after methotrexate, or with significant pain, an adnexal mass of 35 mm or larger, a fetal heartbeat visible on ultrasound, or beta-hCG 5,000 IU/L or more.^[1] Between 1,500 and 5,000 IU/L with all other criteria met, the patient chooses between methotrexate and surgery; methotrexate has a higher chance of needing further intervention.^[1]

• Offer salpingectomy unless there are other risk factors for infertility; consider salpingotomy if there is contralateral tubal damage, informing the patient that up to 1 in 5 need further treatment.^[1]
• After salpingotomy, check hCG weekly from day 7 until negative; after salpingectomy, a urine pregnancy test at 3 weeks.^[1]
• Anti-D immunoglobulin prophylaxis is no longer offered up to and including 11+6 weeks' gestation for ectopic pregnancy or miscarriage (NICE NG126, updated 17 June 2026); from 12+0 to 12+6 weeks it is offered at a dose of at least 250 IU to RhD-negative women having medical or surgical management. Earlier RCOG Green-top 22 / BCSH-based practice differed.^[1]

RCOG Green-top guideline No. 21 (2016) takes a slightly more permissive line on expectant management, offering it when the pregnancy is stable and decreasing with hCG initially under 1,500 IU/L.^[3] ACOG weighs in on the same territory, and US-derived data summarised with ACOG's practice bulletin emphasise that methotrexate is offered for unruptured tubal pregnancies under standard size criteria.^[2][7] Where the bodies differ, our reading is to follow the patient's stability first, and the hCG and size thresholds second.

Ovarian or adnexal torsion is an acute surgical emergency: partial or complete rotation of the ovary on its pedicle compromises blood supply.^[6] It is uncommon, about 2.7% of gynaecological presentations, and the diagnosis is easily missed because the symptoms are non-specific (sudden unilateral pain, nausea and vomiting, sometimes intermittent over hours).^[6] Torsion is commoner in children and women of reproductive age, notably in the early weeks of pregnancy and early postpartum, and an otherwise normal ovary can twist; most often a benign adnexal mass acts as the centre of rotation.^[6]

The examination is misleading. Doppler flow may be absent (highly specific), but normal colour flow is seen in around 60% of surgically confirmed cases, so Doppler cannot exclude torsion.^[6] The diagnostic clues are an adnexal mass that is enlarged, hypoechoic and heterogeneous, with peripherally displaced follicles and, ideally, the "whirlpool sign" of a twisted pedicle.^[6]

Management: presumptive diagnosis in the right clinical setting is enough to justify urgent laparoscopy with detorsion, because the ovary often recovers even when it looks dusky, and ovarian conservation is the goal. Delay risks infarction. Cystectomy of the causative mass follows detorsion.

Haemorrhagic follicular or corpus luteal cysts commonly cause acute pain, often in the luteal phase, and 2.5-3.0 cm follicles can grow to 3-8 cm.^[6] They rupture with sudden onset pain and complex or echogenic free fluid in the pelvis, sometimes with significant haemoperitoneum and collapse.^[6] Most settle with analgesia, rest and review. Operate when the woman is unstable, when bleeding is not self-limiting, or when ectopic pregnancy or torsion cannot be safely excluded. ^[1]

PID is a spectrum of infection of the upper genital tract: endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis.^[5] Sexually transmitted organisms (Neisseria gonorrhoeae, Chlamydia trachomatis) are implicated in many cases, though endogenous vaginal and cervical flora, especially anaerobes, cause most of the rest; ascending infection from the vagina accounts for about 85% of cases.^[4] Roughly half of acute PID cases have a positive test for gonorrhoea or chlamydia.^[5]

PID is a clinical diagnosis. Presumptive treatment should be started when an at-risk woman has pelvic or lower abdominal pain, no other cause is identified, and one or more of three minimum criteria are present: cervical motion tenderness, uterine tenderness or adnexal tenderness.^[5] Adding the presence of mucopurulent discharge, abundant white cells on wet prep, temperature above 38.3 C, elevated ESR or CRP, or documented cervical infection with gonorrhoea or chlamydia increases specificity.^[5] If cervical discharge is normal and no white cells are seen on wet prep, PID is unlikely and an alternative cause should be sought.^[5]

A clinical diagnosis has a positive predictive value for salpingitis of 65% to 90% compared with laparoscopy, and the value is higher in sexually active young women.^[5] Because untreated PID can be sterilising, a low diagnostic threshold is appropriate, and starting antibiotics for presumed PID is unlikely to harm other causes such as ectopic pregnancy, appendicitis or torsion.^[5]

Admit for IV antibiotics when any of the following apply: appendicitis or another surgical emergency cannot be excluded; tubo-ovarian abscess; pregnancy; severe illness, nausea and vomiting, or oral temperature above 38.5 C; inability to tolerate or comply with oral treatment; or failure to respond to oral therapy within 72 hours.^[5] Admit to hospital if the patient is shocked or septic. Pregnancy with PID carries high risk of maternal morbidity and preterm delivery and requires inpatient IV treatment.^[5] The WSES note on life-threatening IAI applies equally here: delay of surgical source control beyond 6 hours from sepsis onset worsens outcomes.^[4]

Duration is 14 days in all regimens. The choice is guided by severity and by whether parenteral therapy is needed.^[5]

Outpatient (IM or oral) regimen: ceftriaxone 500 mg IM as a single dose, plus doxycycline 100 mg by mouth twice daily for 14 days, with metronidazole 500 mg by mouth twice daily for 14 days. Alternatives include cefoxitin 2 g IM with probenecid 1 g orally concurrently, or another parenteral third-generation cephalosporin, in each case plus doxycycline 100 mg by mouth twice daily and metronidazole 500 mg by mouth twice daily for 14 days.^[5] For women weighing more than 150 kg with documented gonococcal infection, ceftriaxone 1 g is used.^[5]

Parenteral regimen: ceftriaxone 1 g IV every 24 hours, plus doxycycline 100 mg by mouth or IV every 12 hours, plus metronidazole 500 mg by mouth or IV every 12 hours. Alternatives are cefotetan 2 g IV every 12 hours or cefoxitin 2 g IV every 6 hours, both with doxycycline 100 mg every 12 hours; oral and IV doxycycline and metronidazole have similar bioavailability.^[5] Transition to oral therapy can usually be made within 24 to 48 hours of clinical improvement; in tubo-ovarian abscess, more than 24 hours of inpatient observation is recommended.^[5]

Quinolone regimens are no longer recommended first-line because of quinolone-resistant Neisseria gonorrhoeae; they are reserved for cephalosporin-allergic patients in low-prevalence settings.^[5]

Tubo-ovarian abscess is drained by ultrasound- or CT-guided catheters (transgluteal, transvaginal or transrectal) when antibiotics alone are not enough.^[6]

Outcomes:

• Review clinically within 72 hours when treated as an outpatient; if no improvement, admit, reassess the diagnosis and the regimen, and consider diagnostic laparoscopy.^[5]
• Women with chlamydial or gonococcal PID are retested at 3 months.^[5]
• All women, including those admitted for sepsis, expect improvement within 72 hours of starting therapy.^[5]
• Sexual contacts in the 60 days before symptom onset should be evaluated, tested and presumptively treated for chlamydia and gonorrhoea; only the most recent partner is treated if last intercourse was more than 60 days before.^[5]
• IUDs need not be removed when PID is diagnosed, but should be considered if there is no clinical improvement within 48 to 72 hours.^[5]

Acute appendicitis is the commonest cause of intra-abdominal infection in the WSES series: luminal obstruction (appendicolith) produces bacterial overgrowth, raised pressure, gangrene or perforation, and abscess or diffuse peritonitis.^[4] Its pain starts central and migrates to the right iliac fossa, with anorexia and focal guarding; many patients have a raised neutrophil count. Surgical assessment should not be delayed. Appendicitis is also the most common non-obstetric surgical cause of abdominal pain in pregnancy.

Other causes that compete with gynaecological disease in the same patient: renal or ureteric colic and urinary tract infection, constipation and bowel disease, musculoskeletal and abdominal wall pain, endometriosis flare, and functional pain (which is itself a diagnosis of exclusion and not a reason to stop looking).

The ACR appropriateness criteria, cited by the radiology review, place transvaginal (and transabdominal) ultrasound as the recommended primary imaging modality in women of reproductive age with a negative pregnancy test when a gynaecological cause is suspected.^[6] Where ultrasound is inconclusive, or in later pregnancy, MRI and in selected cases CT follow.^[6]

Pregnancy alters the pathway: ultrasound and MRI are the preferred imaging tools, CT is avoided because of ionising radiation and teratogenic risk, and every pregnant patient is treated as an obstetric emergency until the cause is clear.^[6]

A pregnant woman with acute pelvic pain is managed as an obstetric emergency. Imaging is ultrasound first, then MRI; CT is reserved. Appendicitis is the commonest non-obstetric surgical cause. A suspected ectopic in pregnancy dominates decision-making even when the presentation is atypical; shoulder-tip pain, syncope and a rigid abdomen are warning signs. Pregnant women with PID should be admitted for IV antibiotics.^[5]

PID is common and often asymptomatic in this group, and a low threshold for presumptive treatment is justified. Ovarian torsion is also commoner in adolescents. Explain treatment in terms they can use, and arrange chaperoned examination and appropriate safeguarding links.

PID diagnosed in an IUD user does not require device removal at the outset, but consider removal if there is no clinical improvement within 48 to 72 hours.^[5] In practice, document the date of insertion: most procedure-related infection occurs in the first 3 weeks.

• Urine beta-hCG and bedside ultrasound are transformational; a negative ultrasound in a haemodynamically stable patient with low hCG allows expectant management and avoids laparoscopy.^[1][6]
• Where transvaginal scanning is unavailable, transabdominal scanning plus careful clinical review is acceptable, but radiation-heavy CT should be avoided.
• Methotrexate, broad-spectrum parenteral antibiotics and laparoscopic equipment may not be available; stabilisation and transfer to a surgical centre is then the plan.
• Where pathology laboratory access is limited, save tumour or tubal specimens for histology whenever surgery is undertaken.

• Acute pelvic pain in a woman of reproductive age is an emergency until proven otherwise; the first step is resuscitation and a pregnancy test.
• Pregnancy status is established before imaging, because it changes both the imaging pathway (ultrasound first, avoid CT) and the diagnoses.
• The dangerous causes are ruptured ectopic pregnancy, sepsis from PID or tubo-ovarian abscess, ovarian torsion and ruptured cyst with significant bleeding.
• Transvaginal ultrasound is first-line imaging once pregnancy is excluded or the patient is stable; it diagnoses ectopic location, adnexal masses, torsion and cyst rupture.
• Ectopic pregnancy accounts for about 2% of pregnancies; the tube is the site in about 90%; estimates of patients with no risk factors range from about a third (NICE) to about a half (ACOG).
• Do not diagnose or exclude ectopic pregnancy on a single hCG or a "discriminatory zone"; use serial values and imaging, and act on symptoms first.
• Treat unruptured tubal ectopics: expectant if stable, under 35 mm, no heartbeat, hCG 1,000 IU/L or less; methotrexate under 35 mm, no heartbeat, hCG under 1,500 IU/L; first-line surgery if 35 mm or larger, heartbeat present, hCG 5,000 IU/L or more, or no reliable follow-up.
• Ovarian torsion is an acute surgical emergency; normal Doppler flow does not exclude it in around 60% of cases, and laparoscopy with detorsion is indicated on the right clinical and ultrasound picture. ^[6]
• Ruptured haemorrhagic cysts are common and usually settle with supportive care, but exclude ectopic and torsion first.
• PID is diagnosed clinically with a low threshold (cervical, uterine or adnexal tenderness); treat with ceftriaxone, doxycycline and metronidazole for 14 days, by outpatient IM/oral route in mild disease and IV route in severe disease, with re-evaluation within 72 hours. ^[5]
• Other lower abdominal pain is unlikely to be harmed by starting antibiotics for suspected PID while the diagnosis is being confirmed.
• Shoulder-tip pain, syncope and haemodynamic instability mean haemorrhage, usually from a ruptured ectopic, until proven otherwise.
• Pregnancy status alters every management step; never skip the test.

• Ectopic pregnancy (gynaecology/ectopic-pregnancy)
• Pelvic inflammatory disease (gynaecology/pelvic-inflammatory-disease)
• Early pregnancy complications (obstetrics/early-pregnancy-complications)
• Adnexal and ovarian masses (gynaecology/adnexal-masses)
• Acute appendicitis (surgery/acute-appendicitis)
• Sepsis (infectious-diseases/sepsis)
• Miscarriage and early pregnancy assessment (obstetrics/miscarriage)