Acute abdomen in pregnancy in tertiary referral center: diagnostic challenges and surgical outcomes

Aims: Acute abdomen during pregnancy is a challenging clinical condition requiring prompt diagnosis and management to prevent adverse maternal and fetal outcomes. This study aimed to evaluate the clinical characteristics, diagnostic approaches, and surgical outcomes of pregnant patients presenting with acute abdomen. Methods: This single-center retrospective study included 13 pregnant patients diagnosed with acute abdomen who underwent surgical intervention (laparotomy or laparoscopy) between October 2025 and January 2026. Demographic, clinical, laboratory, imaging, surgical, and obstetric outcomes were analyzed. Statistical analyses were performed using non-parametric tests, and correlations were assessed using Spearman’s method. Results: The median maternal age was 29 years, and the median gestational age at admission was 24 weeks. The most common diagnosis was ovarian torsion (53.8%), followed by less frequent conditions including appendicitis and other etiologies. Ultrasound was used in all patients, while magnetic resonance imaging was performed in selected cases (15.4%). Laparotomy was the predominant surgical approach (92.3%). Maternal and neonatal outcomes were generally favorable, with a median delivery at 37 weeks and a low rate of neonatal intensive care unit admission (15.4%). A significant association was observed between trimester and pain duration (p=0.027). Additionally, a strong negative correlation was found between gestational age at admission and the interval from diagnosis to delivery (rho = -0.97, p < 0.001). Conclusion: Acute abdomen in pregnancy requires timely diagnosis and a multidisciplinary approach. Gynecological causes, particularly ovarian torsion, may predominate in surgically managed cases. Early intervention is associated with favorable maternal and neonatal outcomes.