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

Objective To explore the impact of the COVID-19 pandemic on mental health of Obstetricians and Gynaecologists Study Design We performed a survey-based study from doctors working in the field of Obstetrics and Gynaecology across all Hospitals in United Kingdom. Surveyed information included demographics, past history of mental health conditions, screening for current symptoms of depression and anxiety, the significance of contributory factors and the effects of mental health on workplace behaviour. Results 207 doctors completed the survey. Of the respondents, 22.2% (n=46) had previously received treatment for a mental health condition. During the COVID-19 pandemic, O&G doctors as compared to UK-wide population estimate, reported significantly higher rates of both Major Depressive Disorder (15.94% versus 3.3%, p=0.023) and Generalised Anxiety Disorder (24.64% versus 5.9%, p=0.044). Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (27.5% versus 12.50%, p=0.047). Respondents felt that the most significant factors for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only 38.65% of respondents agreed that they felt able to talk to colleagues about their mental health. Conclusions This is the first reported study that assesses the impact of COVID-19 on mental health amongst Obstetricians and Gynaecologists. Further research should focus on assessing if changes in the way rapidly changing guidelines and protocols are disseminated reduces the impact on mental health. Ongoing efforts are also needed to improve support networks and encourage normality around discussing mental health amongst doctors