Takeaway
- This meta-analysis suggests that the use of misoprostol at open myomectomy reduces blood loss and the need for blood transfusion with no effect on postoperative pyrexia.
- Preoperative misoprostol is inexpensive, readily available, and has an acceptable side-effect profile; routine preoperative use should be encouraged in women undergoing open myomectomy with no contraindication.
Study design
- Meta-analysis of 8 randomised controlled trials including 385 women who underwent open myomectomy for symptomatic fibroid (192 received misoprostol).
- Primary outcomes: blood loss, drop in haemoglobin and need for blood transfusion.
- Funding: None disclosed.
- Preoperative misoprostol vs placebo was significantly associated with:
- reduced blood loss (standardised mean difference [SMD], −169.56 mL; 95% CI, −200.70 to −138.41).
- lower drop in haemoglobin (SMD, −0.48 g/dL; 95% CI, −0.65 to −0.31);
- lower need for blood transfusion (OR, 0.29; 95% CI, 0.16 to 0.52); and
- reduction in operative time (SMD, −11.64 minutes; 95% CI, −15.73 to −7.54; P<.00001 for all).
- No difference was observed in postoperative pyrexia (OR, 1.27; 95% CI, 0.58-2.78; P=.56) and length of postoperative stay (SMD, −0.14 days; 95% CI, −0.31 to 0.04; P=.12) between groups.
- Results are applicable to more complex operations involving larger number and/or size of fibroids than those in the included studies.
References
References
