Assessing the Effect of the COVID-19 Pandemic on the Rate and Management of Ectopic Pregnancy

STUDY OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on the rate and management of ectopic pregnancies. With the decrease of in-person wellness visits, there is concern for decreased STI screening and treatment of asymptomatic infections that may contribute to ectopic pregnancy rate. In addition, patient delay in presentation to care leads to later diagnoses of ectopic pregnancy and increased need for utilization of surgical management. DESIGN: This is a retrospective cohort study. The pre-Covid-19 data were collected from March 2019 through February 2020 and compared to data from October 2020 through September 2021. Data compared included the number of ectopic pregnancies and management strategy. SETTING: Tertiary care, academic medical center. PATIENTS OR PARTICIPANTS: 54 diagnosed ectopic pregnancies in the pre-pandemic phase and 66 diagnosed ectopic pregnancies in post-pandemic phase. INTERVENTIONS: Billing diagnosis codes and surgical cases were reviewed for the pre-COVID-19 period and from the post-COVID-19 period. Data for each ectopic subject included site of ectopic, laterality, quantitative HCG, ultrasound findings of free fluid and whether surgical or medical management was performed. MEASUREMENTS AND MAIN RESULTS: 54 ectopic pregnancies were diagnosed pre-COVID-19 and 66 were diagnosed post-COVID. The rate of surgical management in the post-COVID-19 group was 77.8% vs 61.1% in the pre-COVID-19 group (p < 0.05). Thus, ectopic pregnancies in post-pandemic period were more likely to require surgery. Further, the total rate of ectopic pregnancy is also rising to a statistically significant degree. CONCLUSION: There is a statistically significant increase in rate of ectopic pregnancies requiring surgical management since the start of the COVID-19 pandemic. This is significant as early diagnosis and management of ectopic pregnancies can oftentimes prevent surgical management. Further study to be completed to evaluate the reasons for this during a time when resource management and allocation has been so tightly managed.