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).