Document Type : Original Article
Authors
1
MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
2
Department of Obstetrics and Gynecology, Faculty of Medicine, New Giza University, Giza
3
Lecturer ob&gyn kasr al aini hospital cairo university
Abstract
Background: To summarize evidence from randomized controlled trials(RCTs) on safety and efficacy of various blood loss-minimizing drugs during open(OM) and mini-mally invasive(MI) myomectomy.
Methods: We searched PubMed, Cochrane library, Sco-pus, Web of Science, and Google Scholar since inception till September 2023. We included RCTs of women under-going OM or MI myomectomy(hysteroscopic or laparo-scopic) who received vasopressin, misoprostol, oxytocin, carbetocin, tranexamic or ascorbic acids, and epineph-rine. Study quality was assessed using Cochrane risk of bias 2(ROB2) tool. Effect measures were reported as risk ratios(RR) or mean differences[MD] with a 95% confi-dence interval[CI]. Primary outcomes were intraoperative blood loss & blood transfusion requirement.
Results: Sixty-one RCTs(n= 4932 patients) were includ-ed. In OM(48 RCTs, 3902 patients), Vasopressin plus Misoprostol were the best to decrease intraoperative blood loss(MD= -714.57, 95% CI -929.98 to -499.17),followed by Bupivacaine + Epinephrine(MD: -651.26, 95%CI -846.8 to -455.72). Also, Vasopressin + Misoprostol was the best in lowering need for blood transfusion( RR: 0.08, 95%CI 0.03 to 0.22),then Octreotide acetate(RR: 0.16, 95%CI 0.03 to 0.79). In MI myomectomy(13 RCTs, N=1030 patients), Oxytocin was the most effective in reducing operative blood loss(MD: -175.5, 95%CI -313.13 to -37.87), followed by Omi-pressin(MD: -149.6, 95%CI -212.8 to 86.4). Also, oxytocin is the most effective in low-ering transfusion requirements(RR: 0.18, 95%CI 0.04 - 0.75),then vasopressin + miso-prostol(RR: 0.17, 95%CI 0.01 to 4.27).
Conclusion: Vasopressin plus misoprostol and oxytocin could be beneficial in lowering need for blood transfusion and intraoperative blood loss during open and minimally inva-sive myomectomies, respectively. Neverthe-less, quality of evidence is low(GRADE 2/4).
Synopsis: Vasopressin plus misoprostol and oxytocin were the best to decrease intraoper-ative bleeding and blood transfusion require-ments in open and minimally invasive myo-mectomy, respectively.
Keywords
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