Abstract
Objective
To compare the efficacy and safety of intramyometrial vasopressin plus rectal misoprostol
with intramyometrial vasopressin alone to reduce blood loss during laparoscopic myomectomy.
Study design
A randomized, single-blind, controlled trial was conducted at All India Institute
of Medical Sciences, New Delhi, India. Sixty women with symptomatic leiomyoma scheduled
for laparoscopic myomectomy were recruited for the study. Thirty women received intramyometrial
vasopressin plus rectal misoprostol (30 min before procedure) (Group I) and 30 women
received intramyometrial vasopressin alone (Group II) during laparoscopic myomectomy.
The primary outcome measure was intra-operative blood loss during surgery. Secondary
outcome measures included decrease in postoperative haemoglobin, ease of enucleation
of myomas, duration of surgery, need for additional haemostatic measures or blood
transfusion, intra- and postoperative morbidity, and duration of hospital stay.
Results
The baseline demographic features and characteristics of leiomyomas were comparable
in both groups. The mean (±standard deviation) blood loss in Group I was 139 ± 96.7 ml,
which was significantly less than that for Group II (206 ± 101.2 ml) (p = 0.008). The mean postoperative haemoglobin was 11.6 ± 1.3 g/dl in Group I and 10.0
± 1.2 g/dl in Group II (p = 0.001). Although blood loss was not clinically significant in either group, the
decrease in haemoglobin was significantly higher in Group II. The mean score for ease
of enucleation (surgeon-rated measure) was significantly lower in Group I (2.6 ± 1.1)
compared with Group II (3.4 ± 1.1) (p = 0.029). Intra- and postoperative vital signs, duration of surgery, need for blood
transfusion and postoperative morbidity were comparable in both groups.
Conclusions
The addition of rectal misoprostol to intramyometrial vasopressin led to a significant
reduction in blood loss and decreased the postoperative drop in haemoglobin. The combination
also improved the ease of enucleation of myomas.
Keywords
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References
- High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence.Am J Obstet Gynecol. 2003; 188: 100-107
- Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy.Hum Reprod. 2000; 15: 2663-2668
- The techniques and results of myomectomy.Lancet. 1931; 220: 171-177
- The management of perioperative bleeding.Blood Rev. 2003; 17: 179-185
- Interventions to reduce haemorrhage during myomectomy for fibroids.Cochrane Database Syst Rev. 2014; 8: CD005355
- Vasopressin as a hemostatic ingynecologic surgery: a preliminary report.Obstet Gynecol. 1958; 11: 363
- A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy.Obstet Gynecol. 1996; 87: 1014-1018
- The use of single versus double dose of intra-vaginal prostaglandin E2 "misoprostol" prior to abdominal myomectomy: a randomized controlled clinical trial.J Reprod Infertil. 2014; 15: 152-156
- Absorption kinetics of misoprostol with oral or vaginal administration.Obstet Gynecol. 1997; 90: 88-92
- Intravaginal misoprostol reduces intraoperative blood loss in minimally invasive myomectomy: a randomized clinical trial.Clin Exp Obstet Gynecol. 2011; 38: 46-49
- Use of misoprostol in myomectomy: a systematic review and meta-analysis.Arch Gynecol Obstet. 2015; 292: 1185-1191
- Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assistedmyomectomy.Obstet Gynecol. 2009; 113: 484-486
- Intramyometrial vasopressin as a hemostatic agent during myomectomy.BJOG. 1994; 101: 435-437
- Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy.Fertil Steril. 2003; 79: 1207-1210
- Characterization of the prostanoid receptors mediating constriction and relaxation of human isolated uterine artery.Br J Pharmacol. 1995; 116: 1692-1696
- A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy.Fertil Steril. 2013; 100: 1044-1049
- Use of vasopressin vs epinephrine to reduce haemorrhage during myomectomy: a randomized controlled trial.Eur J Obstet Gynecol Reprod Biol. 2015; 195: 177-181
- A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial.Arch Gynecol Obstet. 2015; 292: 155-158
- Oral, rectal, and vaginal pharmacokinetics of misoprostol.Obstet Gynecol. 2004; 103: 866-870
Article info
Publication history
Published online: July 05, 2018
Accepted:
July 3,
2018
Received in revised form:
May 28,
2018
Received:
April 17,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
