Investigating and Comparing the Effects of Vasopressin Injection around Uterine Myoma and Rectal Misoprostol Injection in open Myomectomy Surgery to Reduce Bleeding: A Randomized Interventional Study

Authors

  • Masih Ghahiri Medical Doctor, Esfahan University of Medical Sciences, Esfahan, Iran Author
  • Saeedeh Kordjazi Obstetrics and Gynecologist, Department of Obstetrics and Gynecology, Esfahan University of Medical Sciences, Esfahan, Iran Author
  • Ataollah Ghahiri Professor, Department of Obstetrics and Gynecology, Esfahan University of Medical Sciences, Esfahan, Iran Author

DOI:

https://doi.org/10.61841/8cg57s13

Keywords:

Vasopressin, Misoprostol, Myomectomy

Abstract

The objective of this study was to compare the effects of vasopressin injection around the uterine myoma in open myomectomy with misoprostol rectal surgery to reduce bleeding during the surgery and the level of changes in hemoglobin. In a clinical trial study, 66 patients who were candidates for open myomectomy were randomly divided into two groups (each group included 33 patients). The first group received 400 µg of misoprostol 30 minutes before rectal surgery, and the second group received a 20-unit vasopressin ampoule in 19 ml of dissolved normal saline 30 minutes before the surgery. The bleeding volume and hemoglobin level before and after the surgery were measured in two groups and compared with independent and paired t-tests. The mean bleeding volume in the two misoprostol and vasopressin groups was 199.4 ± 370.9 and 261.5 ± 120.3 ml, respectively. The mean lost blood was lower in the vasopressin group (p=0.009). The mean changes in hemoglobin level in the misoprostol and vasopressin groups were 1.68 ± 0.63 and 1.3 ± 0.55 g / dl, respectively, and the difference between two groups was significant (p = 0.01). Based on the results of our study, vasopressin seems to be more effective than misoprostol in controlling bleeding during myomectomy, but due to inconsistencies in the results of different studies, further studies on these two drugs are recommended to determine the most effective drug in controlling bleeding during the myomectomy surgery. 

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References

1. Zaloudek CJ, Hendrickson MR, Soslow RA. Mesenchymal tumors of the uterus. Blaustein’s pathology of

the female genital tract. 2011:453-527.

2. Kongnyuy EJ, Wiysonge CS. Intervention to reduce hemorrhage during myomectomy for fibroids.

Cochrane Database syst Rv.2014; 15:8CD005355-58

3. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine

leiomyoma in Black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100–7.

4. Saadatnia G, Saremi A, Salehian B, Salehian P. Uterine Leiomyoma and Reproductive Tract Infections

Detected by polymerase chain reaction. Iranian Journal of Pathology. 2019 Jan 1; 14(1):15-17

5. Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, et al.Uterine artery Embolization

for treatment of leiomyomata: long-term outcomes from the fibroid registry. Obstet Gynecol 2008; 111:22–

3.

6. Tulandi T, Salamah K. Fertility and uterine artery embolization. Obstet Gynecol 2010;115:857–60.

7. Kim CH, Kim SR, Lee HA, Kim SH, Chae HD, Kang BM. Transvaginal ultrasound-guided radiofrequency

myolysis for uterine myomas. Hum Re-prod 2012; 26:559–63.

8. Dubuisson J, Fauconnier A, Deffarges J, Norgaard C, Kreiker G, Chapron C.Pregnancy outcome and

deliveries following laparoscopic myomectomy.Hum Reprod 2000;15:869–73.

9. Neilson JP. Interventions to reduce haemorrhage during myomectomy for fibroids [Comment on Kongnyuy

EJ, Wiysonge CS. Cochrane Database Syst Rev 2007; 1: CD005355.]. Obstet Gynecol 2007; 109: 1197–8.

10. 10. Alyssa W, Chun C, Sik Y.Transcervical intralesional vasopressin injection compared with placebo in

hysteroscopic myomectomy.The American College of Obstetricians and Gynecologists, 2014; 897-903.

11. Protopapas A, Giannoulis G, Chatzipapas I, Athanasiou S, Grigoriadis T, Kathopoulis N, Vlachos DE,

Zaharakis D, Loutradis D. Vasopressin during Laparoscopic Myomectomy: Does It Really Extend Its

Limits?. Journal of minimally invasive gynecology. 2019 Mar 1; 26(3):441-9.

12. Agostini A, RondaI, Franchi F, Ronda B, Ludovic RC, Bernard B. Oxytocin during myomectomy: a

randomized study. Eur J Obstet Gynecol Reprod Biol; 2005; 118:235–8.

13. Samanta S, Samanta S, Jain K, Chatterjee D. Intramyometrial terlipressin in atonic postpartum hemorrhage:

A uterine salvage decision. Anaesthesia, Pain & Intensive Care. 2019 May 20.

14. Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A.Reducing blood loss at open

myomectomy using triple tourniquets: a randomized controlled trial. Int J Gynecol Obstet 2005; 112:340–5.

15. Benassi L, Lopopolo G, Pazzoni F, Ricci L, Kaihura C, Piazza F, et al. Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy. J Am Coll Surg 2000; 191: 65–9.

16. Zullo F, Palomba S, Corea D, Pellicano M, Russo T, Falbo A, et al. Bupivacaineplus epinephrine for

Laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol 2004; 104:243–9.

17. Chen C. Laparoscopic myomectomy for large myomas. Int Surg 2006; 91(Suppl):S77–80.

18. Jonathan S. Berek and Novaks Gynecology. 15th edition 2012; vol. 1:423-40.

19. SinhaR, Sundaram M,Lakhotia S,Mahajan C, RajeS,KadamP,RaoG.Lapa-roscopic myomectomy with

Uterine artery ligation: review article and comparative analysis. J Gynecol Endosc Surg 2012; 2:3–10.

20. Elsheikh A, Antsaklis A, Mesogitis S, Papantoniou N, Rodolakis A, Vogas E,et al. Use of misoprostol for

the termination of second trimester pregnan-cies. Arch Gynecol Obstet 2001; 265:204–6.

21. Bugalho A, Daniel A, Faundes A, Cunha M. Misoprostol for prevention of postpartum hemorrhage. Int J

Gynaecol Obstet 2001; 73:16.

22. Muhammad R, Isah A, Agida T, Akaba G. A prospective study to compare the effectiveness of adjunctive

rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at-risk

patients. African health sciences. 2019; 19(1):1517-24.

23. Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is efficacious for patients who undergo

abdominal myomectomy. Fertil Steril2003; 79:1207–10

24. Sharifa F, Joseph F, Horance F.A trial comparing the use of rectal misoprostol plus perivascular vasopressin

alone to decrease myometrial bleeding at the time of abdominal myomectomy. Fertility and Sterility 2013;

vol. 100: 1044-49.

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Published

31.05.2020

How to Cite

Ghahiri, M., Kordjazi, S., & Ghahiri, A. (2020). Investigating and Comparing the Effects of Vasopressin Injection around Uterine Myoma and Rectal Misoprostol Injection in open Myomectomy Surgery to Reduce Bleeding: A Randomized Interventional Study. International Journal of Psychosocial Rehabilitation, 24(3), 1907-1913. https://doi.org/10.61841/8cg57s13