Context: Diagnosis and differential diagnosis of genital pathology in urgent states, when acute situations in obstetrics and gynecology must be differentiated from acute surgical pathology, are an urgent trend in the study of gynecological diseases in adolescent girls. Objectives. The purpose of the present work is to investigate the frequency and characteristics of acute obstetric-gynecological states in adolescent girls and to improve the quality of diagnostic approaches to choosing the tactics of therapy for these conditions. Methods. The study involved 529 female patients, younger than 18, who had different obstetric-gynecological pathologies (in 2016-2017) and were hospitalized and treated in Kharkiv Regional Children's Clinical Hospital № 1, - 419 (79,2%) of them - urgently. (In 2012-2013 were 285 patients and 185 (64,8%) of them - urgently). The all-round investigation comprised: general clinical and gynecological examination, ultrasonic scanning, computer tomography, nuclear magnetic resonance, hormonal profile, vaginoscopy, colposcopy, bacteriological, citological, serological tests, chromosome analysis, study of cancer markers and consultations of a pediatric surgeon, an urologist, a pediatrician. Results. In the course of the examination of urgent pathology were diagnosed: pregnancy - 10 (1 of them being ectopic, 1 - non-developing pregnancy), menstrual disoders (abnormal pubertal uterine bleeding - 81, dysmenorrhea - 19), tumours and tumour-like formations of the ovaries - 146 (some cases with torsion of an ovarian cysts), ovulatory syndrome - 38, congenital developmental defects of the genitals - 16, inflammation of genital tract - 44 (vulvovaginitis, acute salpingo-oophoritis), breast pathology (including acute mastitis) - 34, injuries of the sex organs - 26 and 5 cases of ovarian apoplexy. Operative treatment was performed in 105 cases (90% - laparoscopically), in 2012-2013 - 119 cases (70% - laparoscopically). Conclusions. The increased frequency of urgent pathological conditions in pediatric and adolescent gynecology in the Kharkov region over the past five years has been established. Urgent states in pediatric and adolescent gynecology require differential-diagnostic measures with an obligatory highly skilled examination.