Introduction
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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 delay in diagnosis (2-7). EP 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 treatment. Laparoscopic surgery is increasingly becoming the gold standard for surgical management (9). Concerns regarding the theoretical risks of surgery during the COVID-19 pandemic – including the use of aerosol generating procedures such as general anaesthetics and use of pneumoperitoneum and electrosurgery during laparoscopy (10, 11)- contributed to significant changes in clinical management to prevent contamination of healthcare professionals (12-14). Within a few months, advice from learned societies to change protocols for presentation in early pregnancy assessment units (15) and recommendations around the safe use of laparoscopy for emergency treatment during the pandemic were released (16-18).
The economic stability of all nations during the pandemic has been tested based upon their ability to anticipate and cope with the effects, resist the adverse outcomes and recover from the negative impacts. To address the above four vulnerability parameters effectively it is necessary to identify effective and safe methods of healthcare delivery. It is imperative to identify protocols and services that work effectively and in alignment with the restrictions brought about by the pandemic. Keeping these essential national policies in mind, we have looked at the effect the pandemic has had on the management of one of the most common acute life-threatening disease conditions in Gynaecology: ectopic pregnancy (EP).
Ideal pathways for the management of EP are through early pregnancy assessment units as exemplified in the UK. All NHS Trusts offer a structured emergency gynaecology service (early pregnancy unit or EPU), where women can self-refer with early pregnancy symptoms such as pain or vaginal bleeding. This helps to avoid prolonged waiting time and improves patient safety (19). Previous reviews focusing on pregnancy outcomes during the COVID-19 pandemic have suggested an increase in surgical management of EP (20). However, the quality of published evidence is varied and the results are conflicting. This rapid review compares the management of ectopic pregnancies during COVID-19 peak waves versus prior standard practice. Additionally, it assesses the impact of the pandemic on the risk of ectopic pregnancy rupture and the reported complication rates. Finally, we specifically compare those outcomes across units with or without early pregnancy assessment infrastructure (EPU).