Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 6/2015

01-12-2015 | Review

Use of misoprostol in myomectomy: a systematic review and meta-analysis

Authors: Christos Iavazzo, Ioannis Mamais, Ioannis D. Gkegkes

Published in: Archives of Gynecology and Obstetrics | Issue 6/2015

Login to get access

Abstract

Introduction

Misoprostol, a prostaglandin derivative, reduces blood flow to uterus, facilitating every surgical operation on myometrium.

Method

PubMed, Scopus and Cochrane databases were systematically searched and five studies met the inclusion criteria for our meta-analysis.

Results

In total, 283 patients were included. The intention to treat population included 142 patients. The mean age of the patients was 34 years old. The vaginal route of administration was preferred in 117 out of 142 patients and the rectal route in 25 patients. Three studies were included in the analysis regarding duration of operation, estimated blood loss, preoperative/postoperative hemoglobin, transfusions needed and febrile morbidity. No significant difference was observed between vaginal suppository and placebo group concerning the duration of operation, the fall of preoperative hemoglobin, transfusions needed and the febrile morbidity. Regarding the estimated blood loss, the mean difference observed between the misoprostol and placebo groups was −148.55 mL per operation (95 % CI, −233.10 to −64), p < 0.001. As far as the postoperative Hgb, the misoprostol group presented significantly smaller reduction, 0.68 gr/dL per operation (95 % CI, 0.38–0.97), p < 0.001.

Conclusion

Easy to use, minor or no side effects, and good clinical outcomes are the properties that render misoprostol useful in the realization myomectomy independently of the surgical technique applied.
Literature
1.
go back to reference Tang OS, Gemzell-Danielsson K, Ho PC (2007) Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 99(Suppl 2):S160–S167CrossRefPubMed Tang OS, Gemzell-Danielsson K, Ho PC (2007) Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 99(Suppl 2):S160–S167CrossRefPubMed
2.
go back to reference Choksuchat C (2010) Clinical use of misoprostol in nonpregnant women: review article. J Minim Invasive Gynecol 17:449–455CrossRefPubMed Choksuchat C (2010) Clinical use of misoprostol in nonpregnant women: review article. J Minim Invasive Gynecol 17:449–455CrossRefPubMed
3.
go back to reference Goldberg AB, Carusi DA, Meckstroth KR (2003) Misoprostol in gynecology. Curr Womens Health Rep 3:475–483PubMed Goldberg AB, Carusi DA, Meckstroth KR (2003) Misoprostol in gynecology. Curr Womens Health Rep 3:475–483PubMed
4.
go back to reference Hofmeyr GJ, Walraven G, Gulmezoglu AM, Maholwana B, Alfirevic Z, Villar J (2005) Misoprostol to treat postpartum haemorrhage: a systematic review. BJOG 112:547–553CrossRefPubMed Hofmeyr GJ, Walraven G, Gulmezoglu AM, Maholwana B, Alfirevic Z, Villar J (2005) Misoprostol to treat postpartum haemorrhage: a systematic review. BJOG 112:547–553CrossRefPubMed
5.
go back to reference Brown SE, Toner JP, Schnorr JA et al (2001) Vaginal misoprostol enhances intrauterine insemination. Hum Reprod 16:96–101CrossRefPubMed Brown SE, Toner JP, Schnorr JA et al (2001) Vaginal misoprostol enhances intrauterine insemination. Hum Reprod 16:96–101CrossRefPubMed
6.
go back to reference Kongnyuy EJ, Wiysonge CS (2014) Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 8:CD005355 Kongnyuy EJ, Wiysonge CS (2014) Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 8:CD005355
7.
go back to reference Yip SK, Tse AO, Haines CJ, Chung TK (2000) Misoprostol’s effect on uterine arterial blood flow and fetal heart rate in early pregnancy. Obstet Gynecol 95:232–235CrossRefPubMed Yip SK, Tse AO, Haines CJ, Chung TK (2000) Misoprostol’s effect on uterine arterial blood flow and fetal heart rate in early pregnancy. Obstet Gynecol 95:232–235CrossRefPubMed
8.
go back to reference Celik H, Sapmaz E (2003) Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 79:1207–1210CrossRefPubMed Celik H, Sapmaz E (2003) Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 79:1207–1210CrossRefPubMed
9.
go back to reference Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMed Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMed
10.
go back to reference Moher D, Pham B, Jones A et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613CrossRefPubMed Moher D, Pham B, Jones A et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613CrossRefPubMed
11.
go back to reference Niroomand N, Hajiha S, Tabrizi NM, Ghajarzadeh M. A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial. Arch Gynecol Obstet 2015 Niroomand N, Hajiha S, Tabrizi NM, Ghajarzadeh M. A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial. Arch Gynecol Obstet 2015
12.
go back to reference Ragab A, Khaiary M, Badawy A (2014) 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 15:152–156PubMedCentralPubMed Ragab A, Khaiary M, Badawy A (2014) 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 15:152–156PubMedCentralPubMed
13.
go back to reference Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W (2013) 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 100:1044–1049CrossRefPubMed Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W (2013) 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 100:1044–1049CrossRefPubMed
14.
go back to reference Kalogiannidis I, Xiromeritis P, Prapas N, Prapas Y (2011) Intravaginal misoprostol reduces intraoperative blood loss in minimally invasive myomectomy: a randomized clinical trial. Clin Exp Obstet Gynecol 38:46–49PubMed Kalogiannidis I, Xiromeritis P, Prapas N, Prapas Y (2011) Intravaginal misoprostol reduces intraoperative blood loss in minimally invasive myomectomy: a randomized clinical trial. Clin Exp Obstet Gynecol 38:46–49PubMed
15.
go back to reference Agostini A, Ronda I, Franchi F et al (2005) Oxytocin during myomectomy: a randomized study. Eur J Obstet Gynecol Reprod Biol 118:235–238CrossRefPubMed Agostini A, Ronda I, Franchi F et al (2005) Oxytocin during myomectomy: a randomized study. Eur J Obstet Gynecol Reprod Biol 118:235–238CrossRefPubMed
16.
go back to reference Ikechebelu JI, Ezeama CO, Obiechina NJ (2010) The use of torniquet to reduce blood loss at myomectomy. Niger J Clin Pract 13:154–158PubMed Ikechebelu JI, Ezeama CO, Obiechina NJ (2010) The use of torniquet to reduce blood loss at myomectomy. Niger J Clin Pract 13:154–158PubMed
17.
go back to reference Shokeir T, Shalaby H, Nabil H, Barakat R (2013) Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study. Eur J Obstet Gynecol Reprod Biol 166:61–64CrossRefPubMed Shokeir T, Shalaby H, Nabil H, Barakat R (2013) Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study. Eur J Obstet Gynecol Reprod Biol 166:61–64CrossRefPubMed
18.
go back to reference Vercellino G, Erdemoglu E, Joe A et al (2012) Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy. Arch Gynecol Obstet 286:1181–1186CrossRefPubMed Vercellino G, Erdemoglu E, Joe A et al (2012) Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy. Arch Gynecol Obstet 286:1181–1186CrossRefPubMed
19.
go back to reference Benassi L, Lopopolo G, Pazzoni F et al (2000) Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy. J Am Coll Surg 191:65–69CrossRefPubMed Benassi L, Lopopolo G, Pazzoni F et al (2000) Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy. J Am Coll Surg 191:65–69CrossRefPubMed
20.
go back to reference Lumsden MA (2002) Embolization versus myomectomy versus hysterectomy: which is best, when? Hum Reprod 17:253–259CrossRefPubMed Lumsden MA (2002) Embolization versus myomectomy versus hysterectomy: which is best, when? Hum Reprod 17:253–259CrossRefPubMed
21.
go back to reference Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z (2014) Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2:CD003249 Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z (2014) Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2:CD003249
22.
go back to reference Law KS, Abbott JA, Lyons SD (2014) Energy sources for gynecologic laparoscopic surgery: a review of the literature. Obstet Gynecol Surv 69:763–776CrossRefPubMed Law KS, Abbott JA, Lyons SD (2014) Energy sources for gynecologic laparoscopic surgery: a review of the literature. Obstet Gynecol Surv 69:763–776CrossRefPubMed
Metadata
Title
Use of misoprostol in myomectomy: a systematic review and meta-analysis
Authors
Christos Iavazzo
Ioannis Mamais
Ioannis D. Gkegkes
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 6/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3779-x

Other articles of this Issue 6/2015

Archives of Gynecology and Obstetrics 6/2015 Go to the issue