The impact of the coronavirus disease 2019 pandemic on the clinical presentation of tubal ectopic pregnancies: a retrospective cohort study

Yavuz, Onur; Kurt, Sefa; Özgözen, Mehmet Eyüphan; Akdöner, Aslı

doi:10.1590/1806-9282.20231445

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 70 (5) • 2024 • https://doi.org/10.1590/1806-9282.20231445 copy

The impact of the coronavirus disease 2019 pandemic on the clinical presentation of tubal ectopic pregnancies: a retrospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

We aimed to assess the impact of the coronavirus disease 2019 pandemic on the clinical presentation of tubal ectopic pregnancies.

METHODS:

This retrospective cohort study was conducted at a tertiary center and included 76 cases of tubal ectopic pregnancies. The study period was divided into two groups: the pre-coronavirus disease group (January 2018 to February 2020, Group 1; n=47, 61.8%) and the coronavirus disease group (March 2020 to February 2022, Group 2; n=29, 38.2%). Subgroup analysis was also performed for tubal ruptured ectopic pregnancies as Group 1 (n=15, 62.5%) and Group 2 (n=9, 37.5%).

RESULTS:

No statistically significant differences were observed between the pre-coronavirus disease and coronavirus disease groups in terms of demographic characteristics. Although the serum beta-human chorionic gonadotropin level was found to be higher in Group 2, the difference was not statistically significant (p=0.7). The groups appeared to be similar in treatment management, duration of hospitalization, and blood transfusion needs (p=0.3, p=0.6, and p=0.5, respectively). Additionally, no significant difference was observed between the groups in the evaluation of ruptured ectopic pregnancies (p=0.5). In the subgroup analysis of tubal ruptured ectopic pregnancies, no significant difference was observed.

CONCLUSION:

To the best of our knowledge, there are few studies evaluating the effect of the pandemic on tubal ectopic pregnancies in the literature. Although we did not report statistically significant differences between groups in our study, given the potential prolonged duration of the pandemic, healthcare professionals should actively prompt their patients to seek necessary medical assistance.

KEYWORDS:
COVID-19; Ectopic pregnancy; Pandemic

	Group 1 n=47 (61.8%)	Group 2 n=29 (38.2%)	All cases n=76 (100%)	p-value
Maternal age (years)	32 (22–41)	34 (21–45)	32.5 (21–45)	0.9
Gravida	2 (1–10)	2 (1–6)	2 (1–10)	0.9
Parity	0 (0–3)	1 (0–4)	1 (0–4)	0.2
Previous abortion	23/47 (48.9%)	10/29 (34.5%)	33/76 (43.4%)	0.2
Previous ectopic pregnancy	9/47 (19.1%)	3/29 (10.3%)	12/76 (15.8%)	0.2
Previous C/S	13/47 (27.7%)	5/29 (17.2%)	18/76 (23.7%)	0.2
IUD	1/47 (2.1%)	0/29 (0%)	1/76 (1.3%)	0.6
OCP	0/47 (0%)	0/29 (0%)	0/76 (0%)	–
Smoking habits	4/47 (8.5%)	1/29 (3.4%)	5/76 (5.5%)	0.3
Previous gynecological operation	5/47 (10.6%)	8/29 (27.6%)	13/76 (17.1%)	0.05
Assisted reproduction	4/47 (8.5%)	5/29 (17.2%)	9/76 (11.8%)	0.2
Gestation age^c cBased on menstrual dates.	6 (4–9)	6 (5–9)	6 (4–9)	0.4
Prior ultrasound	33/47 (70.2%)	20/29 (69%)	53/76 (69.7%)	0.5

	Group 1 n=47 (61.8%)	Group 2 n=29 (38.2%)	All cases n=76 (100%)	p-value
A) Clinical findings
Abdominal pain	36/47 (76.6%)	17/29 (58.6%)	53/76 (69.7%)	0.08
Vaginal bleeding	40/47 (85.1%)	21/29 (72.4%)	61/76 (80.3%)	0.1
B) Laboratory at presentation
β-hCG level (IU/mL)	2,261 (57–53,000)	2,450 (75–26,980)	2,301 (57–53,000)	0.7
Hemoglobin (g/dL)	11.9 (8.1–14.4)	11.8 (9.4–14.6)	11.8 (8.1–14.6)	0.7
C) Ultrasonography
Embryonic cardiac motion	4/47 (8.5%)	0/29 (0%)	4/76 (5.3%)	0.1
Increased intraabdominal free fluid^c cEstimated by the physician during the ultrasound examination.	15/47 (31.9%)	9/29 (31%)	24/76 (31.6%)	0.5
D) Ruptured ectopic pregnancy	15/47 (31.9%)	9/29 (31%)	24/76 (31.6%)	0.5
E) Treatment management				0.3
Expectant	4/47 (8.5%)	4/29 (13.5%)	8/76 (10.5%)	0.4
Methotrexate	19/47 (40.4%)	9/29 (31%)	28/76 (36.8%)	0.4
Additional methotrexate dose requirements	5/47 (10.6%)	3/29 (10.3%)	8/76 (10.5%)	0.9
Laparoscopic salpingectomy	12/47 (25.5%)	12/29 (41.4%)	24/76 (31.6%)	0.1
Laparatomic salpingectomy	7/47 (14.9%)	1/29 (3.4%)	8/76 (10.5%)	0.1
Methotrexate failure	1/19 (5.3%)	2/9 (22.5%)	3/28 (10.7%)	0.1
F) Hospitalization (days)	2 (1–7)	1 (1–14)	2 (1–14)	0.6
G) Blood transfusion needs	7/47 (14.9%)	5/29 (17.2%)	12/76 (15.8%)	0.5

	Group 1 n=15 (62.5%)	Group 2 n=9 (37.5%)	All cases n=24 (100%)	p-value
A) Surgery management				0.08
Laparoscopic salpingectomy	8/15 (53.3%)	8/9 (89%)	16/24 (66.6%)
Laparatomic salpingectomy	7/15 (46.7%)	1/9 (11%)	8/24 (33.3%)
B) Laboratory findings
α - hCG level (IU/mL)	3,621 (57–53,000)	8,888 (152–26,980)	4,186 (57–53,000)	0.2
Preoperative hemoglobin (g/dL)	11.8 (8.1–13.4)	12.6 (9.4–13.2)	12 (8.1–13.4)	0.2
Postoperative hemoglobin (g/dL)	8.3 (6.1–12.2)	9 (6.6–12.1)	8.7 (6.1–12.2)	0.2
Hemoglobin drop (g/dL)	1.3 (0.6–5.7)	2.8 (0.6–5.7)	2.1 (0.6–5.7)	0.08
C) Ultrasonography findings
Increased abdominal free fluid^c cEstimated by the physician during the ultrasound examination.	15/15 (100%)	9/9 (100%)	24/24 (100%)	–
D) Intraoperative free fluid^d dIntraoperative observation by the surgeon of free fluid filling at least the Douglas pouch.	15/15 (100%)	9/9 (100%)	24/24 (100%)	–
E) Hospitalization (days)	3 (2–4)	3 (2–14)	3 (2–14)	0.8
F) Blood transfusion needs	7/15 (46.6%)	4/9 (44.4%)	11/24 (45.8)	0.6

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: o-yavuz@hotmail.com