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1. Big picture

Emergency gynaecology deals with acute conditions in non-pregnant, possibly pregnant, early pregnant, adolescent, reproductive-age, and postmenopausal patients that can rapidly threaten life, fertility, or future reproductive function.

The safest exam opening is:

Any reproductive-age woman with acute pelvic pain or vaginal bleeding
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Is pregnant until proven otherwise
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Do ABCDE, pregnancy test, haemodynamic assessment
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Resuscitate first if unstable
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Then localize: bleeding / pain / infection / mass / trauma

The examiner wants you to recognize five emergency patterns:

Emergency pattern	Think of
Acute pelvic pain + positive β-hCG	Ectopic pregnancy until proven otherwise
Acute unilateral pelvic pain + vomiting	Adnexal/ovarian torsion
Sudden pain after known cyst	Ruptured or bleeding ovarian cyst
Pelvic pain + fever + discharge	Pelvic inflammatory disease or tubo-ovarian abscess
Heavy bleeding + shock/anaemia	Acute abnormal uterine bleeding, miscarriage, ectopic, trauma

1. Big picture

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