To fight or to flee? -- a systematic review of ectopic pregnancy
management during Covid-19.
Abstract
Background: Concerns about virus spread during surgery contributed to
changes in the clinical management of ectopic pregnancies (EP) during
the COVID19 pandemic. Objective: To compare published data on EP
management prior versus during the COVID-19 pandemic and evaluate any
difference in the management, rupture rate and complications where Early
Pregnancy Unit (EPU) structures exist. Search strategy: We performed a
systematic review of the literature using a keyword strategy based on
our PICO criteria. Selection criteria: We included studies which
recruited women diagnosed with ectopic pregnancy and compared the
management during and prior the COVID-19 pandemic peak. Data collection
and Analysis: Three independent reviewers screened the literature and
extracted the data. Meta-analysis of the data was performed on Revman.
Main Results: Our search yielded 34 studies; 12 were included in our
meta-analysis (3122 women). We found no difference in the type of
management of EP between the pre-Covid and Covid cohorts [2714 women,
OR 0.99(0.63-1.55), p=0.96, I2=77%]. We observed a non-statistically
significant reduction of surgical management within the EPU branch
([OR 0.47(0.19-1.13), p=0.09, I2=81%]). There was no difference in
the ectopic rupture rate in units with EPU [OR= 0.66 (0.33-1.31),
p=0.24, I2=37%]. In contrast, in non-EPU (NPEU) the risk of ruptured
EP [OR=2.86(1.84-4.46), p<0.01 I2=13%] and complications
[OR=1.69(1.23-2.31), p=0.001, I2=45%] were increased. Conclusions:
The worldwide trend was not reflected in the UK suggesting that EPU may
have contributed to prompt diagnosis and safe management of EP. Funding:
No funding was received. Keywords: ectopic pregnancy, COVID 19,
meta-analysis, early pregnancy unit