Management of Ectopic Pregnancy Did Not Change During COVID-19

For individuals with ectopic pregnancy, the risk of adverse events such as ruptured ectopic, blood transfusion, and hemoperitoneum was significantly increased during the COVID-19 pandemic, according to a new literature review.

The researchers compared data on ectopic pregnancy management published before the pandemic vs data published after the pandemic and evaluated the differences depending on the presence or absence of early pregnancy unit (EPU) structures.

To select studies for evaluation, they used a keyword strategy and the Population Intervention Comparison and Outcome criteria. After the literature was screened using these methods, 3 independent reviewers agreed on the data extracted. As a result, the researchers identified 34 articles, 12 of which were included based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. They then conducted a meta-analysis of these studies using a random- or fixed-effect model, depending on the heterogeneity of the study evaluated.

These methods enabled the researchers to evaluate the management of ectopic pregnancies in 3122 women. Outcomes of interest included the type of management, incidence of ruptured ectopic pregnancy, and complication rate. Complications included blood transfusion or iron infusion, hemoperitoneum of more than 1 L, admission to the intensive care unit, significant operative procedure, prolonged hospitalization, and repeat procedure. The researchers also compared units that had EPU structures with units that did not.

Between the pre-COVID-19 period and the COVID-19 period, no difference was found in the use of surgical vs nonsurgical management, although surgical management decreased in EPU structures during the outbreak. Moreover, no difference was found in the rate of ectopic pregnancy rupture in EPU structures. However, in non-EPU structures, the risk of ectopic pregnancy rupture had increased, as did the complication rate.

These findings led the researchers to conclude: “The risk of ruptured ectopic [pregnancy] and complications was significantly higher in the absence of EPU structures […] suggesting that EPU structures contributed to prompt diagnosis and safe management.”

—Ellen Kurek

Reference:

Morin A, Sideris M, Platts S, Palamarchuk T, Odejinmi F. To fight or to flee? A systematic review of ectopic pregnancy management and complications during the Covid-19 pandemic. In Vivo. 2022;36(4):1570-1579. doi:10.21873/invivo.12867