Objectives
We aimed to assess the diagnosis rates of ectopic pregnancy, management of these cases, and associated complications during the first year of the COVID-19 pandemic compared with the previous year.
Materials and Methods
This is a retrospective chart review of all ectopic pregnancy cases diagnosed at the Brigham and Women’s Hospital between March 2019 and February 2021. The data was divided into the pre-pandemic group that included cases between March 2019 and February 2020, and the pandemic group that included cases diagnosed in the same months of the following year.
Results
Overall there were 147 cases of ectopic pregnancy treated at our hospital in the first year of the pandemic, compared to 143 cases during the year prior. Demographic characteristics were not different between the two groups. In the first year of the pandemic, patients presented with a higher β-HCG level, although this difference did not reach statistical significance (517 vs. 348 IU, P=0.8262). There was no difference observed in hemoglobin level or gestational age at the time of presentation. Medical management with methotrexate was used in 88 cases (59.86%) during the pandemic, compared with 73 cases (51.05%) in the year before (P=0.131). Peak pretreatment β-HCG was higher during the pandemic year, compared with the year prior (751.5 vs 571 IU, P=0.3523). Methotrexate therapy was noted to fail in 8 cases (5.59%) in 2019, increasing to 19 cases (12.93%, P<0.05) in the first year of the pandemic. The number of ruptured ectopic pregnancies was 11 cases (7.69%) in 2019. In the first year of the pandemic, this increased to 24 cases (16.33%, P=0.078).
Conclusion
The number of cases diagnosed with ectopic pregnancy at our hospital slightly increased in the first year of the pandemic. During this year, there was a higher number of cases with failed methotrexate treatment, but other outcomes were similar. We speculate that the increase in methotrexate failure during the first year of the pandemic could be secondary to delays in care and more liberal use of methotrexate therapy given the higher plasma HCG levels noted during the first year of the pandemic. This could have larger implications as we consider care of patients with ectopic pregnancies in future pandemics.
Patient Characteristics and Outcomes
| Age | 33 (30-37) | 33 (30-36) | 0.9268 |
|---|---|---|---|
| BMI | 26.2 (22.9-31.5) | 26.6 (23-31.3) | 0.7591 |
| Gravidity | 2 (1-4) | 2 (1-4) | 0.2996 |
| Parity | 0 (0-1) | 1 (1-2) | 0.3869 |
| Initial β-HCG on presentation | 348 (91-2709) | 517 (103-2658) | 0.8262 |
| HGB at presentation | 12.7 (12-13.4) | 12.7 (12-13.5) | 0.9086 |
| Gestational Age (days) | 44 (40-50) | 43 (39-48) | 0.3523 |
| Estimated Blood Loss (ml) | 50 (10-150) | 55 (15-250) | 0.0290 |
| MTX Treatment | 73 (51.05%) | 88 (59.86%) | 0.131 |
| Peak pretreatment β-HCG | 571 (167-1611) | 751.5 (191-3074) | 0.3481 |
| Failed MTX | 8 (5.59%) | 19 (12.93%) | 0.032 |
| Ruptured Ectopic | 11 (7.69%) | 24 (16.33%) | 0.078 |
Data are presented as Median (IQR) or N (%)
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Footnotes
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Parmida Maghsoudlou: Nothing to disclose; Louisa R. Chatroux: Nothing to disclose; Shabnam Gupta: Nothing to disclose; Mobolaji Ajao: Nothing to disclose; Louise P. King: Nothing to disclose.