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

Sarah Wali, Danai Balfoussia, Dana Touqmatchi, Stephen Quinn
BJOG: An International Journal of Obstetrics and Gynaecology 2020 July 1

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 to 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% CIs were calculated using random effects models. Data was 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 -170.32mls (95% CI, -201.53 to -139.10), lower drop in haemoglobin by -0.48g/dL (95%CI, -0.65 to -0.31), lower need for blood transfusion [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 and 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.

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