The establishment of ultrasonography in daily gynaecological and obstetric practice has increased the rate of diagnosis of ovarian cysts amongst pregnant women. Both assessment and management of ovarian cysts in pregnancy can be challenging. Although most cysts are functional in nature and a conservative approach can be employed, a small proportion will carry some malignant potential. Identifying which cysts can be safely managed expectantly and which necessitate surgical intervention, investigating possible cyst accidents, deciding on the timing and nature of intervention (fine needle aspiration versus cystectomy or even oophorectomy), the surgical approach (laparotomy versus laparoscopy) and balancing the risks and benefits for the mother and the fetus are just a few examples of the dilemmas that need to be addressed, ideally within a multidisciplinary team-based environment.

A 16-year-old nulligravid female presents to the emergency department with abdominal pain. She reports the pain started suddenly two hours prior to arrival and is associated with nausea and vomiting. The pain comes and goes, is located in the right lower quadrant, and is described as sharp and stabbing. She rates the pain as nine out of ten. She denies fever, chills, urinary symptoms, diarrhea, and constipation. She reports never having been sexually active. She has no past medical or surgical history. She is not taking any medications and she has no known drug allergies.

Acute gynaecological emergencies are conditions of the female reproductive system that threaten the woman’s life, her sexual function or her fertility. Common gynaecological emergencies present as acute abdomen, abnormal vaginal bleeding, or a combination of both.

The main gynaecological emergencies could be divided into early pregnancy problems, gynaecologic causes of severe pelvic pain (acute pelvic inflammatory disease, pelvic endometriosis, torsion and rupture of an ovarian neoplasm, torsion or degeneration of a uterine leiomyoma, ovarian hyperstimulation syndrome), severe vaginal bleeding, vulvar abscesses, toxic shock syndrome and sexual violence.