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, 25-27), 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. 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. The pre-Covid timeframes were based on a similar period the year before, 2019, or from 2 previous years (2018 and 2019) or during the months preceding the first Covid wave. The total population of the analysis includes 3122 women; 1828 women in the pre-Covid population versus 1294 women in the Covid population. The two cohorts were matched for demographics in each individual study. EPU system are implemented nationally in the UK only. Studies conducted in Italy, Israel, US and Canada do not have such structures in the hospitals involved.