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To fight or to flee? -- a systematic review of ectopic pregnancy management during Covid-19.
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  • Amelie Morin,
  • Michail Sideris,
  • Sophie Platts,
  • Tetyana Palamarchuk,
  • Funlayo Odejinmi
Amelie Morin
Whipps Cross University Hospital
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Michail Sideris
Queen Mary University of London
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Sophie Platts
Whipps Cross University Hospital
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Tetyana Palamarchuk
Whipps Cross University Hospital
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Funlayo Odejinmi
Whipps Cross University Hospital
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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
03 Dec 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
14 Dec 2021Assigned to Editor
14 Dec 2021Submission Checks Completed
28 Dec 2021Reviewer(s) Assigned
06 Mar 2022Review(s) Completed, Editorial Evaluation Pending