A systematic review of randomized controlled trials to reduce hemorrhage during myomectomy for uterine fibroids.
OBJECTIVE
To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.


METHODS
Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).


RESULTS
We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] -149.00 mL, 95% confidence interval [CI] -229.24 to -68.76); intramyometrial vasopressin and analogues (WMD -298.72 mL, 95% CI -593.10 to -4.34); intramyometrial bupivacaine plus epinephrine (WMD -68.60 mL, 95% CI -93.69 to -43.51); and pericervical tourniquet (WMD -1870.00 mL, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin.


CONCLUSIONS
There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.
Kongnyuy
E J
EJ
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@liverpool.ac.uk
van den Broek
N
N
Wiysonge
C S
CS
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002045:Bupivacaine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D018231:Leiomyomatosis / Q000601:surgery*; D016595:Misoprostol / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014111:Tourniquets; D014594:Uterine Neoplasms / Q000601:surgery*; D014667:Vasopressins / Q000627:therapeutic use
D016595:Misoprostol; D014667:Vasopressins; D010121:Oxytocin; D002045:Bupivacaine