Delayed presentation of ectopic pregnancy during the COVID‐19 pandemic: A retrospective study of a collateral effect

Abstract

Objective We aimed to assess the rates of overall diagnosis of ectopic pregnancy (EP), treatment modality and associated complications during the COVID‐19 pandemic compared to the exact time period in the previous year (pre‐COVID‐19). Methods A retrospective cohort study was conducted at a single referral regional center (Shaare Zedek Medical Center, Jerusalem, Israel). Prevalence of the diagnosis of EP, treatment modality and associated complications during the COVID‐19 lockdown period in the state of Israel (March 10–May 12, 2020) was compared to patients receiving the same diagnosis during the parallel timeframe in the previous year (2019). Results Overall there were 29 and 43 cases of EP during the COVID‐19 and pre COVID‐19 epoch, respectively. COVID‐19 period patients presented to the emergency room with significantly higher β‐human chorionic gonadotrophin level; median of 1364 versus 633 IU, P = 0.001. The rate of ruptured EP was; 20.7% versus 4.3% P = 0.031, and surgical approach; 55.2% versus 27.9%, P = 0.001. Significantly higher median volume of blood loss; median volume 852 versus 300 ml, P = 0.042 were observed in patients during the COVID‐19 epoch. Conclusion The COVID‐19 pandemic led to delayed presentation of patients with EP, and the requirement of subsequent emergency surgical management and excessive blood loss. Special attention should be given to the decline in routine medical care during the pandemic.

Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID‐19 pandemic

“…However, this hypothesis is not supported by the findings of this study. Our findings are also in contrast to those of the currently available literature on the impact of the COVID-19 pandemic on EP diagnosis and management, in which it has been suggested that hesitancy amongst patients in accessing healthcare resources led to an increase in the rates of surgery, ruptured EP, blood loss and hemodynamic instability [8][9][10][11][12][13] .…”

Challenge in challenging times: a case report of ruptured isthmic ectopic pregnancy in an asymptomatic COVID-19 positive patient

“…10 Barg et al have reported that in this pandemic of COVID-19 more women have reported after tubal rupture than before rupture thereby increasing need for emergency surgical management and blood transfusion. 11 In our hospital a policy was made to all elective deferrable surgeries were cancelled, while acute emergencies were managed. The existing health care infrastructure, which was already burdened in non-COVID period was further divided between COVID and non-COVID patients.…”

To fight or to flee? -- a systematic review of ectopic pregnancy management during Covid-19.

“…Included study characteristics 12 studies, involving a total of 3122 women, were eligible for data extraction (Table 1). Five studies were from Europe (UK and Italy) (3) (21) (22) (23,24), four from America (USA and Canada) Gomez (4) (6) (7) (25) and three from the Middle East (Israel) (2,26), (27) . Nine studies were single centre retrospective studies (2, 3, 6)(10) (22,23,(25)(26)(27), one was a multicentred prospective study (21) and two multicentred retrospective studies (4), (24).…”

“…Five studies were from Europe (UK and Italy) (3) (21) (22) (23,24), four from America (USA and Canada) Gomez (4) (6) (7) (25) and three from the Middle East (Israel) (2,26), (27) . Nine studies were single centre retrospective studies (2, 3, 6)(10) (22,23,(25)(26)(27), one was a multicentred prospective study (21) and two multicentred retrospective studies (4), (24). All studies compared a cohort of women diagnosed with an ectopic pregnancy during the first Covid wave in early 2020, with a similar cohort managed pre-Covid: 2018-2019.…”

“…All studies compared a cohort of women diagnosed with an ectopic pregnancy during the first Covid wave in early 2020, with a similar cohort managed pre-Covid: 2018-2019. The Covid timeframes are strictly matched with the national lockdown in four studies (3) (6) (23) (26). The other studies used a timeframe incorporating the lockdown period but extending beyond when restrictions were lifted.…”