Does COVID-19 restrictions affect the detection and management of ectopic pregnancies?

Objective: To assess impact of COVID-19 on diagnosis and management of ectopic pregnancy. Design: Retrospective comparative analysis of ectopic pregnancies (EP) between January and July in 2019 (pre-COVID) and 2020. Setting: Performed at Blackpool Victoria Hospital, a district general hospital in Lancashire. There were no changes in health care personnel and EP management guidelines during both periods, however service provision was modified in line with COVID-19 regulations.Population: We identified 27 EP cases of 1780 total pregnancies presented to early pregnancy unit (EPU) in 2019 compared to 22 cases of 1782 pregnancies in 2020. Methods: Data was collected from EPU computerised database, looking at maternal age, site, side, size and gestation at diagnosis, ruptured EP, different management options. A Chi square statistical analysis compared the variables.Main outcome measures: Gestation at diagnosis and cases of ruptured EP. Secondary outcome measures were the different management options. Results: The incidence of EP cases was similar in 2020 and 2019 (22/1782; 1.23% Vs 27/1780; 1.51%, P=0.512). We found more cases of ruptured EP in 2020 compared to 2019 nonetheless statistically insignificant (6/22; 27.3% Vs 5/27; 18.5%, P=0.467). However, a stark difference noted was the gestation of EP diagnosis, 77.3% presented late (>6wks amenorrhoea) in 2020 compared to 2019, proving to be statistically significant (17/22; 77.3% Vs 25/27; 92.6%, P<0.001). Other parameters like maternal age, site and size of EP, and different management options; were not statistically significant. Conclusions: We urge women to seek help as there are infection prevention measures in place, to provide the services required in early pregnancy.