1 Initial Assessment and Emergency Response

Recognize emergencies early

Obstetric and gynecologic emergencies can worsen quickly. The immediate aim is to recognize danger, protect the patient and responders, assess threats to life, and arrange timely emergency care—not to make a definitive diagnosis.

Ask whether the patient is pregnant or has been pregnant recently. Pregnancy-related complications can occur during pregnancy, birth, and after birth, and a patient may not know they are pregnant. ACOG advises patients to report pregnancy within the past year when seeking care.

Identify time-critical warning signs

Activate EMS—911 in the United States—for severe or rapidly worsening symptoms, including:

• Heavy vaginal bleeding, fainting, confusion, marked weakness, pale or clammy skin, or other signs of shock.

• Severe abdominal or pelvic pain, especially with bleeding, shoulder pain, dizziness, or fainting. These symptoms may signal a ruptured ectopic pregnancy and internal bleeding.

• Seizure, trouble breathing, chest pain, severe persistent headache, or sudden vision changes during pregnancy or after birth.

• Fever with severe pelvic or abdominal pain, or feeling seriously ill with abnormal vaginal discharge.

• Labor with an urge to push, a visible presenting part (crowning), or a birth that appears imminent.

• Sudden collapse or unresponsiveness.

Adnexal torsion is another urgent gynecologic condition. It can present as sudden, severe pelvic pain and needs immediate evaluation. Treat a new, severe, or worsening symptom as urgent when in doubt; do not wait for a pregnancy test or confirmed diagnosis.

Make the scene safe and provide respectful care

Check for hazards before approaching. Use standard precautions and appropriate protective equipment, especially when blood or body fluids are present. Request additional responders or a safer location if needed.

Protect the patient's privacy and dignity. Explain what you are doing, use the patient's preferred name and language where possible, and ask before exposing or touching them. Have a support person remain only if the patient wants them there and it is safe.

Conduct the initial assessment

Use your training and local protocol. Begin with a rapid primary assessment:

1. Responsiveness and immediate threats: Check responsiveness and identify major bleeding, seizure, collapse, or another immediate danger.

2. Airway and breathing: Ensure the airway is open and assess breathing. Support life-threatening problems within your scope.

3. Circulation and bleeding: Check pulse, skin signs, and visible bleeding; look for signs of shock. If possible, do not let a patient with possible shock walk.

4. Get help early: Activate EMS or the emergency response team for red flags. Do not delay transport for a lengthy history or examination.

5. Reassess: Record and repeat vital signs and mental-status checks as your role and equipment allow.

Escalate promptly for abnormal vital signs, altered mental status, severe pain, significant bleeding, seizure, suspected shock, or rapid deterioration.

Gather information and continue care

When the patient is stable enough for brief questions, ask about the main symptom and when it began; pregnancy or recent birth; pain, bleeding, fluid leakage, contractions, or fever; and relevant medical conditions, medications, allergies, and complications. Ask sensitively and in private when feasible about the possibility of pregnancy.

In late pregnancy, if the patient is hypotensive or poorly perfused, position them on their left side or manually displace the uterus to the left if trained and appropriate; follow local protocol. Avoid unnecessary internal examinations or inserting anything into the vagina. Do not try to diagnose the cause of bleeding from its appearance alone.

Keep the patient warm, monitor closely, and communicate important findings and changes to the receiving team.

Obtain consent and respond to refusal

Explain the proposed assessment and care in plain language and seek the patient's consent. Pregnancy alone does not mean a person cannot make decisions. If the patient refuses, assess decision-making capacity within your role, explain the significant risks of refusing emergency evaluation, and contact medical direction according to local policy. Rules vary by jurisdiction, so follow local law and protocol.

If a life-threatening emergency leaves the patient unable to consent, emergency implied consent rules may apply under local law.

Escalate and communicate

Give the receiving team a concise handoff: symptoms and onset, pregnancy or postpartum status if known, vital signs and trends, visible bleeding or other key findings, care provided, and the patient's response.

For cardiac arrest in pregnancy, AHA guidance calls for high-quality CPR, pregnancy-specific modifications, and early team activation. Follow current resuscitation guidance and your scope of practice.