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

Kyriacou, C.; Cooper, Nicole; Robinson, Emily K.; Parker, N.; Barcroft, J.; Kundu, Samit; Letchworth, P.; Sur, S.; Gould, Debby; Stalder, C.; Bourne, Tom

doi:10.1002/uog.24793

Cited by 4 publications

(7 citation statements)

References 22 publications

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“…12 studies, involving a total of 3122 women, were eligible for data extraction (Table I). 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).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Surgical versus non-surgical management. Ten studies involving 2,714 women, reported on the method of management of ectopic pregnancies during Covid compared to a pre-Covid cohort (2,3,6,(21)(22)(23)(24)(25)(26)(27). A total of 719 women underwent surgical management in the pre-Covid cohort versus 551 in the Covid cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Ruptured ectopic rate. Nine studies including 1,531 women compared the number of ruptured ectopic pregnancies during Covid to a matched pre-Covid cohort (2,6,(21)(22)(23)(24)(25)(26)(27). Data collected from these studies were analysed to compare the rate of rupture between the two cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is particularly supported by 2 multicentred studies by Platts and Kyriacou (24). This trend could be explained by the advice from national bodies recommending the use of conservative and medical management for EP during the pandemic (24). This guidance was motivated by safety concerns with the aim to limit hospital foot fall and unnecessary exposure to potential aerosol generating procedures for both patients and staff.…”

Section: Discussionmentioning

confidence: 99%

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To Fight or to Flee? A Systematic Review of Ectopic Pregnancy Management and Complications During the Covid-19 Pandemic

Morin

Sideris

Platts

et al. 2022

In Vivo

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Background/Aim: During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the effect the pandemic had on the management of ectopic pregnancy. Our review compares published data on pre-COVID to COVID management of ectopic pregnancies and evaluates the differences where Early Pregnancy Unit (EPU) structures exist. Materials and Methods: We performed a systematic review of the published evidence using a keyword strategy. The "Population Intervention Comparison and Outcome" (PICO) criteria were used to select studies. Three independent reviewers agreed on the data extracted after screening of the literature. The total population analysed included 3122 women. A meta-analysis of the included studies was completed using a random or fixed effect model depending on the heterogeneity (I 2 ). Our outcomes were the following: type of management of ectopic pregnancy (EP), incidence of ruptured EP and rate of complications. We compared units with and without EPU infrastructure. Results: We included every study which recruited women diagnosed with ectopic pregnancy and compared the type of management during and prior the COVID-19 peak. Our literature search yielded 34 papers. 12 were included using the PRISMA guidelines. We observed no difference in the type of management (surgical versus non-surgical) [OR=0. 99 (0.63-1.55), p=0.96, I 2 =77%] in the pre-Covid vs. Covid cohorts overall but a reduction of surgical management in EPU structures. There was no difference in the ectopic rupture rate within the EPU branch ), p=0.24, I 2 =37%]. In contrast, in non-EPU (NPEU) structures there was a clear increased risk of ruptured ectopic pregnancy [OR=2. 86 (1.84-4.46), p<0.01 I 2 =13%] and complications [OR=1. 69 (1.23-2.31), p=0.001, I 2 =45%]. Conclusion: The risk of ruptured ectopic and complications was significantly higher in the absence of EPU structures. This worldwide trend was not reflected in the UK, where EPU systems are widespread, suggesting that EPU structures contributed to prompt diagnosis and safe management. In the post-COVID era, healthcare systems have come to realise that pandemics might become the norm and thus the onus is to identify services that have worked seamlessly.The risk of ectopic pregnancy (EP) is reported as 1 to 2% of all pregnancies (1). During the COVID-19 pandemic, in an attempt to prevent overwhelming of healthcare systems and reduce community transmission of the virus, governments advised patients to attend hospital only when absolutely necessary. As a result, some studies reported a significant reduction in presentation to emergency gynaecological services, potentially leading to significant delays in diagnoses (2-7). Despite improvements in the management of EP, it still remains associated with significant morbidity and a maternal mortality rate of 0.2 per 1000 in the UK (8). Current management options include expectant, medical and surgical management. Laparoscopic surgery is increasingly b...

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