POMMS: Pre-operative misoprostol in myomectomy surgery: A randomised controlled pilot study

Wetherell, Lima; Kathurusinghe, Shamitha; Dior, Uri; Szabo, Rebecca A; Gilmartin, Christine; Polyakov, Alex; Ross, Vanessa; Dronovalli, Mithilesh; Ang, W. Catarina

doi:10.1016/j.ejogrb.2022.07.008

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…The heterogeneities of studies in terms of factors such as misoprostol administration site or timing, dosage, number of doses, and the timing or techniques used for bleeding evaluation may explain the differences between reported findings. On the other hand, in this study, we found that fibroid size was an independent predictor of hemoglobin reduction, which supports some results in the literature 14,26 . In women with large fibroids who will undergo hysteroscopic myomectomy, it may be beneficial to take other precautions in addition to misoprostol treatment in the preoperative period in order to prevent postoperative hemoglobin decrease in women with large fibroids, and it may be necessary to assess the utility of GnRH‐a treatment—which is effective in reducing myoma size 27 …”

Section: Discussionsupporting

confidence: 86%

“…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 24–26 . Similar to these latter results, we found that misoprostol use was not a predictor of hemoglobin reduction in women who underwent hysteroscopy myomectomy.…”

Section: Discussionsupporting

confidence: 83%

“…11 On the other hand, some studies report no relationship between blood loss and preoperative misoprostol use in women undergoing myomectomy. [24][25][26] Similar to these latter results, we found that misoprostol use was not a predictor of hemoglobin reduction in women who underwent hysteroscopy myomectomy. It is possible that the bleedingpreventive effects of misoprostol may be limited by the number or absolute size of fibroids/myomas in some patients.…”

Section: Discussionsupporting

confidence: 82%

“…On the other hand, in this study, we found that fibroid size was an independent predictor of hemoglobin reduction, which supports some results in the literature. 14,26 In women with large fibroids who will undergo hysteroscopic myomectomy, it may be beneficial to take other precautions in addition to misoprostol treatment in the preoperative period in order to prevent postoperative hemoglobin decrease in women with large fibroids, and it may be necessary to assess the utility of GnRH-a treatment-which is effective in reducing myoma size. 27 In patients undergoing hysteroscopy, pain is mainly produced by cervical dilation, passage of the hysteroscope through the cervical canal, and stretching of the uterus with fluid.…”

Section: Discussionmentioning

confidence: 99%

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

Güven¹,

Avul²

2023

J of Obstet and Gynaecol

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Aim In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy. Methods This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 μg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay. Results The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20–38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001). Conclusions The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population‐based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Güven¹,

Avul²

2023

J of Obstet and Gynaecol

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Laparoscopic myomectomy – The importance of surgical techniques

Dumitrașcu

Nenciu

et al. 2023

Front. Med.

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Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.

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Clinical Efficacy and Safety of Misoprostol During Abdominal Myomectomy: An Updated Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials

Abu-Zaid,

Al Baalharith,

Alsabban

et al. 2024

JCM

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Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as “low” or had “some concerns” of bias in seven and eight RCTs, respectively; one RCT had an overall “high” risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = −180.2 mL, 95% CI [−224.04, −136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = −0.58 g/dl, 95% CI [−0.82, −0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI −3.34, −0.96], p < 0.001), mean operative time (MD = −12.95 min, 95% CI [−19.89, −6.01], p < 0.001), and mean hospital stay (MD = −0.14 days, 95% CI [−0.25, −0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion.

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POMMS: Pre-operative misoprostol in myomectomy surgery: A randomised controlled pilot study

Cited by 3 publications

References 13 publications

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

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

Laparoscopic myomectomy – The importance of surgical techniques

Clinical Efficacy and Safety of Misoprostol During Abdominal Myomectomy: An Updated Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials

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