Misoprostol for open myomectomy: a systematic review and meta-analysis of randomised control trials.
Adult
Blood Loss, Surgical
/ prevention & control
Blood Transfusion
/ statistics & numerical data
Female
Humans
Middle Aged
Misoprostol
/ administration & dosage
Operative Time
Oxytocics
/ administration & dosage
Preoperative Care
/ methods
Randomized Controlled Trials as Topic
Treatment Outcome
Uterine Myomectomy
/ adverse effects
Blood transfusion
clinical practice
haemostasis
meta-analysis
misoprostol
myomectomy
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
accepted:
19
06
2020
pubmed:
3
7
2020
medline:
20
1
2021
entrez:
3
7
2020
Statut:
ppublish
Résumé
Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy. To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra- and postoperative outcomes. PubMed, Cochrane, Scopus, MEDLINE and EMBASE. Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively. The 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. 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 -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [OR] -0.48, 95% CI -0.65 to -0.31), and a reduction in operative time by -11.64 minutes (95% CI -15.73 to -7.54). There was no difference in postoperative pyrexia or length of postoperative stay. 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. Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.
Sections du résumé
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 ANALYSIS
The 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 -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [OR] -0.48, 95% CI -0.65 to -0.31), and a reduction in operative time by -11.64 minutes (95% CI -15.73 to -7.54). 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.
TWEETABLE ABSTRACT
Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.
Identifiants
pubmed: 32613769
doi: 10.1111/1471-0528.16389
doi:
Substances chimiques
Oxytocics
0
Misoprostol
0E43V0BB57
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
476-483Informations de copyright
© 2020 Royal College of Obstetricians and Gynaecologists.
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