Misoprostol for open myomectomy: a systematic review and meta‐analysis of randomised control trials

Abstract

Background Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy.Objective To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra-and postoperative outcomes.Search strategy PubMed, Cochrane, Scopus, MEDLINE and EMBASE.Selection criteria Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively. Data collection and analysisThe revised Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias. Primary outcomes were blood loss, drop in haemoglobin and need for blood transfusion. Secondary outcomes were operative time, postoperative pyrexia and length of postoperative stay. Pooled effect sizes with corresponding 95% CI were calculated using random effects models. Data were analysed using two statistical models for statistical reliability.Results Eight studies were included with a total of 385 patients, of which 192 received misoprostol. Preoperative misoprostol was significantly associated with lower blood loss by À170.32 ml (95% CI À201.53 to À139.10), lower drop in haemoglobin by À0.48 g/ dl (95% CI À0.65 to À0.31), reduced need for blood transfusion (odds ratio [OR] À0.48, 95% CI À0.65 to À0.31), and a reduction in operative time by À11.64 minutes (95% CI À15.73 to À7.54). There was no difference in postoperative pyrexia or length of postoperative stay.Conclusion Moderate-to high-quality studies have established that misoprostol minimises blood loss and need for blood transfusion at open myomectomy. This low-cost and readily available drug should be routinely administered prior to open myomectomy to improve clinical outcomes.

Evaluation of the effect of preoperative rectal misoprostol use on the postoperative outcomes of hysteroscopic myomectomy

“…A meta‐analysis evaluating misoprostol, oxytocin, vasopressin, tranexamic acid, epinephrine, or ascorbic acid among different types of myomectomy reported that misoprostol and ornipressin were the least effective drugs in shortening hospital stay 36 . In two meta‐analyses drawing data from randomized controlled trials, no relationship was found between the use of misoprostol and length of hospital stay in women who underwent myomectomy 5,23 . In the current study, no relationship was found between hospital stay and misoprostol use, consistent with the results in the literature.…”

“…In other studies, similar beneficial results were reported for the amount of bleeding and Hb values in women using misoprostol 14,16–22 . In a meta‐analysis evaluating randomized controlled trials, preoperative use of misoprostol in open myomectomy was associated with less blood loss, less decrease in hemoglobin, and fewer cases needing blood transfusion 23 . In another meta‐analysis, vaginal misoprostol recipients were reported experience lower levels of blood loss and hemoglobin decrease 11 .…”

“…14,[16][17][18][19][20][21][22] In a meta-analysis evaluating randomized controlled trials, preoperative use of misoprostol in open myomectomy was associated with less blood loss, less decrease in hemoglobin, and fewer cases needing blood transfusion. 23 In another meta-analysis, vaginal misoprostol recipients were reported experience lower levels of blood loss and hemoglobin decrease. 11 On the other hand, some studies report no relationship between blood loss and preoperative misoprostol use in women undergoing myomectomy.…”

“…The effects of excessive blood loss in myomectomy can range from anemia, blood transfusion, hysterectomy, prolonged hospital stay, to much more severe events, and potentially, death 23 . There are numerous studies evaluating length of hospital stay in myomectomy patients who received misoprostol.…”

In Low- and Middle-Income Countries the Uterine Tourniquet during Open Myomectomy is a Simple and Efficient Method of Reducing Blood Loss

“…Indeed, ordered but undelivered transfusions are a health security problem in our country [5]. The uterine tourniquet technique allows reduction of both intraoperative hemorrhage, and transfusion needs during abdominal myomectomies better than use of misoprostol [15][16][17][18], oxytocics [13], gonadotrophin releasing hormon (GnRH) agonists [10] and tranexamic acid [19][20][21]. The uterine tourniquet has also shown its superiority over bilateral primary ligation of hypogastric arteries, which is reserved for experienced surgeons [15].…”