What Are Obstetric & Gynaecology Emergencies and Why Do They Matter in the ED?


In the ED, obstetric and gynaecology emergencies mainly include:


  • Early pregnancy problems – ectopic pregnancy, miscarriage, hyperemesis gravidarum. (NICE)
  • Hypertensive disorders of pregnancy – severe pre-eclampsia and eclampsia. (NICE)
  • Acute pelvic pain – ovarian torsion, ruptured ovarian cyst, pelvic inflammatory disease (PID), tubo-ovarian abscess. (RCOG)
  • Major haemorrhage – early pregnancy haemorrhage, antepartum haemorrhage (APH), and occasionally postpartum haemorrhage (PPH) presenting or deteriorating in ED. (rcemlearning.co.uk)


They are time-critical, high-risk for both mother and fetus, and frequently appear in the FRCEM SBA as vignettes testing recognition, initial stabilisation, and appropriate referral based on NICE and RCOG guidance.


H2: How Obstetric & Gynaecology Emergencies Appear in the FRCEM SBA Exam


Common angles:

  • Diagnosis / recognition
    • Early pregnancy bleeding → differentiate ectopic pregnancy, miscarriage, and normal pregnancy. (NICE) 
    • Severe headache / visual disturbance / hypertension → pre-eclampsia/eclampsia. (NICE) 
    • Sudden unilateral pelvic pain → consider ovarian torsion. (RCOG)


  • Initial investigation choice
     
  • Pregnancy test + transvaginal ultrasound ± serial β-hCG for early pregnancy bleeding. (NICE) 
  • BP, urine dip for protein, U&Es, LFTs, platelets in suspected pre-eclampsia. (NICE) 
  • Pelvic ultrasound/Doppler in suspected torsion or ovarian mass.


  • First-line management


  • ABC, IV access, fluids, group & save / crossmatch in haemorrhage.
  • Magnesium sulphate and antihypertensives in eclampsia/severe pre-eclampsia. (NICE)
  • Prompt surgical referral for suspected ectopic pregnancy or torsion. (NICE)


  • Complications / red flags


  • Ruptured ectopic → haemorrhagic shock. 
  • Eclampsia → seizures, pulmonary oedema, stroke, HELLP. (NICE) 
  • Ovarian torsion → loss of ovary if delayed. (RCOG)


Example scenario snippet:


A 29-year-old woman, 7 weeks pregnant by dates, presents with lower abdominal pain and vaginal spotting. BP 92/60, HR 118, RR 22. Urinary β-hCG positive. The abdomen is tender in the RIF with cervical motion tenderness. What is the most appropriate next step?


Core Concepts You Must Know About Obstetric & Gynae Emergencies


Because this topic is broad, think in clusters rather than individual conditions.


Early Pregnancy Emergencies – Bleeding, Ectopic Pregnancy, Miscarriage


Definitions & key criteria

  • Early pregnancy bleeding – vaginal bleeding up to 13+6 weeks gestation. (NICE)
  • Ectopic pregnancy – pregnancy implanted outside uterine cavity (most often tubal). UK incidence ~11 per 1000 pregnancies. (RCOG)
  • Miscarriage – spontaneous loss of pregnancy before 24 weeks; NICE early pregnancy guideline focuses on ≤13+6 weeks. (NICE)


Assessment & investigations

  • Always do a pregnancy test in women of child-bearing age with abdominal pain, collapse, or vaginal bleeding.
  • Assess haemodynamic status first (HR, BP, RR, capillary refill, GCS).
  • Perform speculum/bimanual exam if appropriate and safe (avoiding placenta praevia concern in later pregnancy).
  • Arrange urgent transvaginal ultrasound via Early Pregnancy Unit (EPU) if stable. (NICE)
  • Serial β-hCG may be used where pregnancy of unknown location is suspected.


Initial ED management

  • Unstable with suspected ruptured ectopic: 
    • ABCDE, large-bore IV access, fluid resuscitation, bloods including group & crossmatch.
    • Activate major haemorrhage protocol if needed.
    • Urgent obstetrics/gynecology / theatre involvement. (NICE)


  • Stable early pregnancy bleeding: 
    • Confirm pregnancy location via EPU scan per NICE NG126. (NICE)
    • Provide clear safety-netting for pain, bleeding, syncope.


  • Miscarriage: 
    • ED role is stabilisation, analgesia, antiemetics, Rhesus prophylaxis where indicated (anti-D according to gestation and local protocol), and referral to EPU for definitive management (expectant, medical, or surgical). (NICE)


Red flags & pitfalls

  • Pain + bleeding + positive pregnancy test = ectopic until proven otherwise.
  • Normal vitals don’t exclude ectopic; patients may decompensate suddenly. (rcemlearning.co.uk)
  • “Threatened miscarriage” labels should only be used after ultrasound has excluded ectopic and confirmed intrauterine pregnancy.


Hypertensive Disorders – Pre-Eclampsia & Eclampsia


Definitions & key criteria


  • Pre-eclampsia – new onset hypertension (≥140/90) after 20 weeks gestation with proteinuria and/or maternal organ dysfunction or uteroplacental dysfunction. (NICE)
  • Severe hypertension – commonly ≥160/110 mmHg; treat urgently.
  • Eclampsia – occurrence of generalised tonic-clonic seizures in the context of pre-eclampsia.


Assessment & investigations


  • Symptoms: severe headache, visual disturbances, RUQ/epigastric pain, oedema, reduced fetal movements, dyspnoea.
  • Examination: BP in both arms, reflexes, fundal height, signs of pulmonary oedema.
  • Tests: FBC, U&Es, LFTs, coagulation, urine protein, consider CTG/foetal assessment if in maternity area. (NICE)


Initial ED management


  • ABCDE, left lateral tilt, high-flow oxygen if hypoxic.
  • Seizure control: 
    • Magnesium sulphate IV (4 g loading dose then infusion) for eclampsia and often for severe pre-eclampsia where birth is imminent, in line with NICE NG133 / JRCALC. (NICE)
  • Blood pressure control: 
    • IV labetalol or hydralazine are common first-line options (exact choice per local guideline). (NICE)
  • Urgent obstetric involvement – definitive management is delivery in appropriate setting (theatre, labour ward, HDU).


Red flags & pitfalls

  • Missing pre-eclampsia in a woman with headache and visual disturbance but only borderline BP.
  • Not giving magnesium sulphate to a woman who has had an eclamptic seizure. (NICE)


Gynaecology Acute Pelvic Pain – Ovarian Torsion & Others


Definitions & key concepts

  • Ovarian torsion – twisting of ovary ± fallopian tube on its vascular pedicle, often on a background of an ovarian cyst; a surgical emergency. (RCOG)
  • Ruptured ovarian cyst, PID, tubo-ovarian abscess – other causes of acute pelvic pain that mimic torsion.

Assessment & investigations

  • History: sudden onset unilateral pelvic pain, often severe, ± nausea/vomiting; sometimes recurrent intermittent pain from intermittent torsion. (Right Decisions)
  • Examination: adnexal tenderness, cervical motion tenderness (PID).
  • Urine pregnancy test (again: never forget it).
  • Pelvic ultrasound with Doppler – reduced/absent ovarian blood flow may support torsion, but a normal Doppler does not exclude torsion.

Initial ED management

  • Analgesia, antiemetics, IV access, bloods.
  • Early gynaecology-on-call discussion for suspected torsion – definitive management is urgent laparoscopy. (RCOG)

Red flags & pitfalls

  • Repeated analgesia and discharge in a woman with recurrent unilateral pelvic pain and known ovarian cyst; torsion may be intermittent.
  • Over-reliance on Doppler – normal flow does not entirely rule out torsion.


Haemorrhage – Early Pregnancy, APH & PPH in ED


Key concepts

  • Early pregnancy haemorrhage – usually ectopic or miscarriage; see above. (NICE)
  • Antepartum haemorrhage (APH) – bleeding from genital tract after 24 weeks’ gestation, often due to placenta praevia, placental abruption, or local cervical/vaginal causes.
  • Postpartum haemorrhage (PPH) – blood loss >500 mL after vaginal birth or >1000 mL after C-section; sometimes patients present or re-present to ED with ongoing bleeding or collapse.


ED approach

  • ABCDE, major haemorrhage protocol as needed.
  • Large-bore IV access, bloods including FBC, clotting, crossmatch.
  • Consider tranexamic acid early for major obstetric haemorrhage as per local and national guidance.
  • Positioning (left lateral), urgent obstetric team / theatre support.



Special Populations

  • Adolescents – may present late; consider safeguarding and confidential sexual health input.
  • Perimortem caesarean section – in maternal cardiac arrest ≥20–24 weeks, exam may test the indication/timing conceptually (4-minute rule) rather than expecting you to perform it.


Common FRCEM SBA Traps Related to Obstetric & Gynae Emergencies


  • Failing to check pregnancy test
     
    • Trap: Diagnosing “renal colic” or “appendicitis” without doing a pregnancy test. 
  • Fix: Any woman of child-bearing age with abdo pain, collapse, or bleeding → urinary β-hCG.


  • Mis-labelling ectopic as “threatened miscarriage”
  • Trap: Assuming intrauterine pregnancy without scan. 
  • Fix: Only call it “threatened miscarriage” once viable intrauterine pregnancy confirmed on ultrasound per NICE NG126. (NICE)


  • Under-treating eclampsia
  • Trap: Treating seizures with benzodiazepine alone and forgetting magnesium sulphate and BP control. 
  • Fix: For eclamptic fits, magnesium sulphate is the drug of choice, with antihypertensive therapy and urgent obstetric input. (NICE)


  • Delaying referral for suspected torsion
  • Trap: Waiting for “perfect” imaging while the ovary is ischaemic. 
  • Fix: Torsion is a clinical diagnosis; urgent surgical assessment is key.


  • Missing domestic/sexual violence or safeguarding issues
  • Trap: Focusing purely on pathology, ignoring psychosocial risk factors (especially in early pregnancy loss or sexual health presentations). 
  • Fix: Remember safeguarding, early involvement of appropriate teams.



High-Yield Clinical Patterns for Obstetric & Gynae Emergencies in the ED


Classic Presentation – Ruptured Ectopic


32-year-old woman, 6 weeks since LMP, presents with sudden severe lower abdominal pain and dizziness.

BP 84/50, HR 124, RR 24, SpO₂ 95% RA.

Abdomen: generalised tenderness, guarding. Pregnancy test positive.

Pattern: shock + early pregnancy + pain → ruptured ectopic until proven otherwise → resus + urgent theatre. (NICE)


Classic Presentation – Eclampsia

25-year-old at 34 weeks presents after a generalised tonic–clonic seizure.

Post-ictal, BP 172/112, RR 18, SpO₂ 97% RA, protein +++ on urine dip, severe headache and visual disturbance.

Pattern: seizure + severe hypertension + proteinuria → eclampsia → magnesium sulphate, antihypertensives, obstetric emergency. (NICE)


Classic Presentation – Ovarian Torsion

24-year-old with known 6 cm ovarian cyst presents with sudden onset right iliac fossa pain radiating to the back, with vomiting.

Afebrile, HR 104, BP 110/70. Abdomen: marked RIF tenderness, no guarding.

Pattern: young woman + known cyst + sudden unilateral pain + N/V → torsion until proven otherwise, even if Doppler equivocal. (RCOG)


Dangerous Mimics

  • Appendicitis, renal colic, PID, ruptured corpus luteum cyst in early pregnancy.
  • Migraine vs pre-eclampsia; epilepsy vs eclampsia – BP + urine protein + gestation are your clues. (NICE)


How to Revise Obstetric & Gynae Emergencies Efficiently for the FRCEM SBA


Use Question Banks First, Then Guidelines

  1. Do a block of obstetric/gynae SBAs: 
    • Early pregnancy bleeding, ectopic, miscarriage, torsion, pre-eclampsia, eclampsia, PPH.
  2. Then read: 
    • NICE NG126 – Ectopic pregnancy and miscarriage. (NICE)
    • NICE NG133 – Hypertension in pregnancy (pre-eclampsia/eclampsia). (NICE)
    • RCOG Green-top guidelines on ectopic pregnancy and ovarian masses, and local torsion/ovarian cyst guidance. (RCOG)
    • RCEMLearning modules on bleeding in early pregnancy and pregnancy emergencies. (rcemlearning.co.uk)

This keeps your ED practice aligned with UK standards and exam expectations.


Build Mini-Notes or Flashcards from Mistakes


For each obstetric/gynae SBA you miss, record:

  • What the stem tested – e.g. “indications for magnesium in eclampsia”, “what to do in a haemodynamically unstable woman with suspected ectopic”.
  • Why you got it wrong – misread gestation, ignored BP, underestimated severity.
  • One-liner rule – 
    • “Any pregnant woman with seizure + high BP + proteinuria gets magnesium until proven otherwise.” (NICE)
    • “Early pregnancy bleeding + pain = ectopic until proven otherwise.”


Mix Text-Based and Image-Based Questions

  • Text/vignette SBAs for diagnosis and next best step.
  • Add ultrasound descriptions (e.g. no intrauterine pregnancy with β-hCG above discriminatory zone, adnexal mass with free fluid).
  • Eclampsia questions may include CT head scenarios (to exclude intracranial haemorrhage).


How StudyMedical Covers Obstetric & Gynae Emergencies in Its FRCEM SBA Question Bank


StudyMedical’s FRCEM SBA bank weaves obstetric and gynaecology emergencies across Resuscitation, Abdominal Pain, Early Pregnancy, and Medical Complications of Pregnancy:

  • Curriculum-mapped obstetric & gynae vignettes
     
  • Ectopic pregnancy, miscarriage, hyperemesis, pre-eclampsia, eclampsia, PPH, torsion and PID – all written to RCEM 2021 SLOs.
  • Image- and guideline-based SBAs
  • Ultrasound descriptions, CTG/foetal compromise clues where relevant, and stems explicitly based on NICE NG126, NG133 and RCOG guidance.
  • Detailed explanations
  • Each question walks through the diagnostic reasoning, references the correct UK guideline, and highlights the “trick” that examiners were aiming for.


  • Smart revision modes
     
    • Revise new, incorrect, or flagged obstetric/gynae questions to target weak spots until the patterns feel automatic.



FAQs About Obstetric & Gynaecology Emergencies in the FRCEM SBA

How often do obstetric/gynae emergencies appear in the FRCEM SBA exam?
 They’re not the majority of the paper, but they come up reliably, often wrapped into abdominal pain, collapse and resus vignettes.
 What’s the single most important thing to remember about these topics for the exam?
 Always think “could this patient be pregnant?” and if yes, consider ectopic, haemorrhage, and pre-eclampsia first, and manage mother’s ABC before anything else.
 Are there must-know guidelines for obstetric/gynae emergencies?


 Yes:

  • NICE NG126 – Ectopic pregnancy and miscarriage (NICE)
  • NICE NG133 – Hypertension in pregnancy (pre-eclampsia/eclampsia) (NICE)
  • RCOG Green-top guidelines on ectopic pregnancy and ovarian masses/torsion (RCOG)
  • Local maternity/obstetric haemorrhage protocols.


How many obstetric/gynae-related questions should I aim to do before the exam?
 Aim for at least 20–30 focused obstetric/gynae SBAs, plus plenty of mixed abdominal pain and resus questions where pregnancy is part of the differential.


Key Takeaways: Obstetric & Gynae Emergencies for FRCEM in 5 Bullet Points

  • Always check pregnancy status in women of child-bearing age with pain, bleeding or collapse.
  • Treat early pregnancy bleeding + pain as ectopic until proven otherwise and involve EPU/obstetrics early. (NICE)
  • Recognise and treat pre-eclampsia/eclampsia promptly with magnesium sulphate, antihypertensives and senior obstetric input. (NICE)
  • For acute unilateral pelvic pain with known cyst, think ovarian torsion and don’t delay surgical referral. (RCOG)
  • Obstetric/gynae SBAs nearly always hinge on pattern recognition + guideline-aligned first step, so practising realistic vignettes is the fastest way to score marks.


Ready to Test Yourself on Obstetric & Gynae Emergencies?


Obstetric and gynaecology emergencies are high-stakes and very examinable:

  • They combine resuscitation, abdominal pain, and guideline-driven management.
  • Once you’ve seen enough SBAs, the patterns (ectopic, pre-eclampsia, torsion) become obvious and quick to answer.