What are the referral criteria for a patient with an ovarian cyst who presents with acute abdominal pain?

Referral criteria for a patient with an ovarian cyst presenting with acute abdominal pain:

• If physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously due to uterine fibroids), the woman should be referred urgently using a suspected cancer pathway referral to a gynaecological cancer service to be seen within 2 weeks.
• In the presence of acute abdominal pain, if the patient is haemodynamically unstable (signs such as pallor, tachycardia, hypotension, shock, or collapse) or there is significant concern about bleeding or pain severity, immediate referral to Accident and Emergency is indicated.
• For women with acute abdominal pain but stable examination without ascites or mass, measure serum CA125 in primary care. If CA125 is 35 IU/mL or greater, arrange an urgent ultrasound scan of the abdomen and pelvis.
• If the ultrasound suggests ovarian cancer, refer urgently using a suspected cancer pathway referral.
• If CA125 is normal (<35 IU/mL) or raised but ultrasound is normal, assess for other causes and advise the woman to return if symptoms become more frequent or persistent.

These criteria ensure timely identification and referral of women at risk of ovarian cancer or other serious pathology presenting with acute abdominal pain and ovarian cysts.