Emergency Physicians' Confidence in Managing Obstetric and Gynecologic Emergencies in Saudi Arabia: A Cross-Sectional Study

BACKGROUND: Obstetric and gynecologic emergencies are time-sensitive conditions encountered in emergency departments and may result in substantial maternal morbidity and mortality if not promptly recognized and managed. Emergency physicians are frequently the first clinicians to evaluate pregnant patients presenting with acute complications, yet exposure to obstetric emergencies and related procedural training may be limited. This study assessed the confidence of emergency physicians in Saudi Arabia in managing obstetric and gynecologic emergencies and identified factors associated with higher confidence. METHODS: We conducted a cross-sectional survey of emergency physicians practicing in Saudi Arabia between January and March 2026. A structured electronic questionnaire assessed demographic characteristics, training background, clinical exposure to obstetric emergencies, and self-reported confidence in managing specific obstetric conditions and procedures. Confidence was measured using a 5-point Likert scale (1 (not confident) to 5 (very confident)). High confidence was defined as a mean score of ≥4. Descriptive statistics were used to summarize responses, and univariable logistic regression was performed to identify factors associated with high confidence. RESULTS: A total of 214 emergency physicians participated. Most respondents were male (143 of 214, 66.8%) and aged 25-35 years (153 of 214, 71.5%). Formal training in obstetric emergencies during residency was reported by 132 physicians (132 of 214, 61.7%). Participants reported relatively higher confidence in managing hyperemesis gravidarum (mean score: 4.1±0.8) and first-trimester vaginal bleeding (3.9±0.9), whereas lower confidence was reported for shoulder dystocia (2.7±1.2) and emergency delivery in the emergency department (2.8±1.2). Procedural confidence was highest for neonatal resuscitation (3.8±0.9) and pelvic examination (3.6±1.0) and lowest for episiotomy and repair (2.3±1.2). Overall, 76 physicians (76 of 214, 35.5%) met the criteria for high confidence. Factors associated with higher confidence included more than five years of emergency medicine experience (odds ratio (OR): 2.41; 95% CI: 1.45-4.02), formal obstetric emergency training (OR: 2.87; 95% CI: 1.70-4.84), frequent exposure to obstetric emergencies (OR: 3.14; 95% CI: 1.82-5.43), neonatal resuscitation certification (OR: 1.68; 95% CI: 1.01-2.80), and consultant-level practice (OR: 3.56; 95% CI: 1.72-7.35). CONCLUSIONS: Emergency physicians in Saudi Arabia reported variable confidence in managing obstetric and gynecologic emergencies, with lower confidence in complex obstetric conditions and delivery-related procedures. Greater clinical experience, formal training, and more frequent exposure to obstetric emergencies were associated with higher confidence. Targeted educational strategies, including structured obstetric emergency training and simulation-based learning, may help strengthen preparedness for time-critical obstetric emergencies in the emergency department.