Last reviewed: 25 Aug 2021
Last updated: 09 Jul 2021



History and exam

Key diagnostic factors

  • pelvic or abdominal pain
  • nausea, vomiting, or diarrhoea
  • abdominal/pelvic tenderness
  • palpable adnexal mass
  • presence of risk factors

Other diagnostic factors

  • feeding intolerance, vomiting, abdominal distension, and fussiness (neonates)
  • strenuous exercise
  • peritoneal signs
  • cervical motion tenderness
  • fever

Risk factors

  • ovarian neoplasm
  • non-functional ovarian cyst
  • para-ovarian cyst
  • hydrosalpinx
  • pregnancy
  • infertility treatment
  • strenuous exercise
  • sudden increased abdominal pressure
  • polycystic ovary syndrome

Diagnostic investigations

1st investigations to order

  • pregnancy test
  • urinalysis
  • FBC
  • group and save
  • sickle cell test
  • C-reactive protein (CRP)
  • transvaginal ultrasound
  • abdominal or transrectal ultrasound
  • Doppler flow
  • PCR, nucleic acid amplification test, or cervical culture
  • surgical visualisation

Investigations to consider

  • CT abdomen/pelvis
  • MRI abdomen/pelvis

Treatment algorithm


Expert advisers

Jackie Ross, BSc, MBBS, FRCOG

Consultant Gynaecologist and Clinical Lead

Early Pregnancy and Gynaecology Assessment Unit

King’s College Hospital NHS Foundation Trust




JR is Vice Chair of the Association of Early Pregnancy Units and a medical advisor to the Ectopic Pregnancy Trust. She is also a course organiser for the Royal College of Obstetricians and Gynaecologists (RCOG) advanced skills training in Early Pregnancy and Acute Gynaecology, and South London RCOG ultrasound training co-ordinator for Gynaecology.


JR declares that she has no competing interests.


BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Dr Sareena Singh, MD, FACOG

Assistant Professor

Department of Obstetrics and Gynecology

Northeast Ohio Medical University


Chief of Gynecologic Oncology

Aultman Hospital



Disclosures: SS declares that she has no competing interests.

Peer reviewers

Cecilia Bottomley, MBBChir, MD, MRCOG

Consultant Gynaecologist and Clinical Lead for Gynaecology Governance

University College London Hospitals NHS Foundation Trust




CB declares that she has no competing interests.


Susan Mayor,

Section Editor, BMJ Best Practice


SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice


RW declares that she has no competing interests.

Annabel Sidwell,

Comorbidities Editor, BMJ Best Practice


AS declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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