是战斗还是逃避？COVID-19 大流行期间异位妊娠管理和并发症的系统评价。
To Fight or to Flee? A Systematic Review of Ectopic Pregnancy Management and Complications During the Covid-19 Pandemic.
机构信息
Whipps Cross University Hospital, Barts Health NHS Trust, London, U.K.;
Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, U.K.
出版信息
In Vivo. 2022 Jul-Aug;36(4):1570-1579. doi: 10.21873/invivo.12867.
BACKGROUND/AIM: During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the effect the pandemic had on the management of ectopic pregnancy. Our review compares published data on pre-COVID to COVID management of ectopic pregnancies and evaluates the differences where Early Pregnancy Unit (EPU) structures exist.
MATERIALS AND METHODS
We performed a systematic review of the published evidence using a keyword strategy. The "Population Intervention Comparison and Outcome" (PICO) criteria were used to select studies. Three independent reviewers agreed on the data extracted after screening of the literature. The total population analysed included 3122 women. A meta-analysis of the included studies was completed using a random or fixed effect model depending on the heterogeneity (I). Our outcomes were the following: type of management of ectopic pregnancy (EP), incidence of ruptured EP and rate of complications. We compared units with and without EPU infrastructure.
RESULTS
We included every study which recruited women diagnosed with ectopic pregnancy and compared the type of management during and prior the COVID-19 peak. Our literature search yielded 34 papers. 12 were included using the PRISMA guidelines. We observed no difference in the type of management (surgical versus non-surgical) [OR=0.99 (0.63-1.55), p=0.96, I=77%] in the pre-Covid vs. Covid cohorts overall but a reduction of surgical management in EPU structures. There was no difference in the ectopic rupture rate within the EPU branch [OR=0.66 (0.33-1.31), p=0.24, I=37%]. In contrast, in non-EPU (NPEU) structures there was a clear increased risk of ruptured ectopic pregnancy [OR=2.86 (1.84-4.46), p<0.01 I=13%] and complications [OR=1.69 (1.23-2.31), p=0.001, I=45%].
CONCLUSION
The risk of ruptured ectopic and complications was significantly higher in the absence of EPU structures. This worldwide trend was not reflected in the UK, where EPU systems are widespread, suggesting that EPU structures contributed to prompt diagnosis and safe management. In the post-COVID era, healthcare systems have come to realise that pandemics might become the norm and thus the onus is to identify services that have worked seamlessly.
背景/目的：在 COVID-19 大流行期间，人们对手术的理论风险感到担忧，这导致了临床管理的改变，以防止感染。我们观察了大流行对异位妊娠管理的影响。我们的综述比较了 COVID 前和 COVID 期间异位妊娠管理的已发表数据，并评估了存在早期妊娠单位（EPU）结构的差异。
材料和方法
我们使用关键词策略对已发表的证据进行了系统评价。使用“人群干预比较和结局”（PICO）标准选择研究。三名独立评审员对文献筛选后提取的数据达成一致意见。分析的总人群包括 3122 名女性。使用随机或固定效应模型（取决于异质性（I））对纳入的研究进行荟萃分析。我们的结局是：异位妊娠（EP）的管理类型、破裂的 EP 发生率和并发症发生率。我们比较了有无 EPU 基础设施的单位。
结果
我们纳入了每一项招募被诊断为异位妊娠的女性的研究，并比较了 COVID-19 高峰前后的管理类型。我们的文献检索产生了 34 篇论文。根据 PRISMA 指南，有 12 篇论文被纳入。我们观察到，在总体上，COVID 前和 COVID 期间的管理类型（手术与非手术）没有差异[比值比（OR）=0.99（0.63-1.55），p=0.96，I=77%]，但在 EPU 结构中手术管理有所减少。在 EPU 分支中，异位妊娠破裂率没有差异[比值比（OR）=0.66（0.33-1.31），p=0.24，I=37%]。相比之下，在非 EPU（NPEU）结构中，破裂的异位妊娠风险明显增加[比值比（OR）=2.86（1.84-4.46），p<0.01，I=13%]和并发症[比值比（OR）=1.69（1.23-2.31），p=0.001，I=45%]。
结论
在没有 EPU 结构的情况下，破裂的异位妊娠和并发症的风险显著增加。这种全球趋势在英国并没有反映出来，英国广泛存在 EPU 系统，这表明 EPU 结构有助于及时诊断和安全管理。在后 COVID 时代，医疗保健系统已经认识到，大流行可能成为常态，因此，责任在于确定无缝运作的服务。
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