Ultrasound characteristics, serum biochemistry and outcomes for ectopic pregnancies presenting during the SARS-CoV-2 pandemic: retrospective analysis.

Kyriacou, C; Cooper, N; Robinson, E; Parker, N; Barcroft, J; Kundu, S; Letchworth, P; Sur, S; Gould, D; Stalder, C; Bourne, T

OBJECTIVES To describe and then compare the characteristics of ectopic pregnancies (EP) in the year prior to and then during the SARS-CoV-2 pandemic. METHODS This was a retrospective analysis from 1st January 2019 to 31st December 2020 of women diagnosed with an EP (n=275) at a London dual center early pregnancy assessment service. Women were identified via the AstraiaTM ultrasound reporting system using coded and non-coded outcomes of 'EP' or 'pregnancy outside the uterine cavity'. Data relating to predefined outcomes were collected using AstraiaTM and CernerTM electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. Statistical analysis was carried out using GraphPad Prism v8.2.1. RESULTS Similar numbers and proportions of EP were seen in 2019 (n=141, 1%) and 2020 (n=134, 1%). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at first ultrasound and at diagnosis was similar, with no difference in EP location, size or morphology. Human chorionic gonadotrophin (hCG) levels at time of EP diagnosis were higher in 2020 than 2019 (1005 IU/L vs 665 IU/L, p=0.03). The type of final EP management was similar, but more failed first line management during the pandemic (16% vs 6%, p=0.01). Rates of blood visualized on ultrasound within the pelvis (hemoperitoneum) (23% vs 27%, p=0.58) and of rupture confirmed surgically (9% vs 3%, p=0.07) were both similar. CONCLUSIONS No difference was observed in the location, size, morphology and gestational age of ectopic pregnancies. Complication rates and management were also unchanged. HCG levels were higher, and a greater proportion of conservative management measures failed during the pandemic. Our findings suggest women continued to access appropriate care for EP during the SARS-CoV-2 pandemic, with no evidence of diagnostic delay or increase in adverse outcomes in our population. This article is protected by copyright. All rights reserved.