misoprostol and Blood-Loss--Surgical

To conduct the first-ever systematic review and meta-analysis of randomized controlled trials (RCTs) on the antihemorrhagic utility and safety of tranexamic acid (TXA) versus misoprostol for management (prevention and/or treatment) of postpartum hemorrhage (PPH).. Six databases were screened from inception until May 2023 and updated in September 2023. The RCTs were assessed for quality according to the Cochrane's risk of bias tool. The endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model.. Ten RCTs with 2121 patients (TXA = 1061 and misoprostol = 1060) were analyzed. There was no significant difference between TXA and misoprostol groups regarding the mean intraoperative blood loss (n = 9 RCTs, MD = 17.32 ml, 95% CI [-40.43, 75.07], p = 0.56), mean change in hemoglobin (n = 6 RCTs, MD = 0.11 mg/dl, 95% CI [-0.1, 0.31], p = 0.30), mean hospital stay (n = 2 RCTs, MD = -0.3 day, 95% CI [-0.61, 0.01], p = 0.06), blood transfusion rate (n = 4 RCTs, RR = 0.49, 95% CI [0.16, 1.47], p = 0.2), and rate of additional uterotonic agents (n = 4 RCTs, RR = 1.05, 95% CI [0.72, 1.53], p = 0.81). Leave-one-out sensitivity analysis showed robustness of the results, and there was no evidence of publication bias. Regarding safety endpoints, there was no significant difference between both groups regarding the rates of minor side effects, such as diarrhea, fever, nausea, and vomiting. No patient developed thromboembolic events in the TXA group.. There was no significant antihemorrhagic efficacy between adjunct TXA and misoprostol for the management of PPH. The safety profile was comparable between both agents.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Female; Hemostatics; Humans; Misoprostol; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Tranexamic Acid

To evaluate the efficacy of misoprostol to minimized blood loss during and after cesarean delivery (CD).. Screening of MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials from inception to February 2021 using the keywords related to misoprostol, CD, postpartum hemorrhage, and intraoperative blood loss and their MeSH terms.. Only RCTs were included. Participants included women undergoing CD whether elective or selective. Thirty studies including 6593 women, 26 in English, 2 in Thai, 1 in French, and 1 in Chinese.. Data from all selected studies were extracted independently by two authors. Data extracted included location of the trial, sample size, inclusion and exclusion criteria, participants characteristics, intervention details including timing, dose, and route of drug administration. Outcomes assessed included estimated intraoperative and postoperative blood loss, occurrence of postpartum hemorrhage, the need for additional uterotonics, and hemoglobin difference.. Four studies (968 women) compared preoperative to postoperative misoprostol and found a mean difference in intraoperative blood loss of -205.00 (-339.22, -70.77), p = 0.003 and in postoperative blood loss -216.27 (-347.08, -85.46), p < 0.001 and a significantly lower need for additional uterotonics with a risk ratio of 0.54 (0.46, 0.64), p < 0.00001. Twenty-two studies (4701 participants) compared misoprostol to oxytocin. There was a mean difference in intraoperative blood loss of -108.43 (-156.04, -60.82), p < 0.0001. Nine of these trials with 1978 participants evaluated postoperative blood loss. These found a mean difference of -64.12 (-116.19, -12.04) with a p = 0.02. Fourteen trials with 3166 participants measured the difference between preoperative and postoperative hemoglobin. These found a mean difference of -0.25 (-0.35, -0.15) with a p < 0.001. Twenty trials with 4416 participants measured the need for administration of additional uterotonics. These found a risk ratio of 0.62 (0.49, 0.78) with a p value of <0.001.. The combined use of misoprostol and oxytocin during CD is effective in reducing blood loss during and after CD.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Humans; Misoprostol; Oxytocics; Oxytocin; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy

Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy.. To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra- and postoperative outcomes.. PubMed, Cochrane, Scopus, MEDLINE and EMBASE.. Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively.. 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% CI were calculated using random effects models. Data were analysed using two statistical models for statistical reliability.. 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 -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [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 or length of postoperative stay.. 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.. Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Middle Aged; Misoprostol; Operative Time; Oxytocics; Preoperative Care; Randomized Controlled Trials as Topic; Treatment Outcome; Uterine Myomectomy

Misoprostol, a prostaglandin derivative, reduces blood flow to uterus, facilitating every surgical operation on myometrium.. PubMed, Scopus and Cochrane databases were systematically searched and five studies met the inclusion criteria for our meta-analysis.. 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.. 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.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Leiomyoma; Misoprostol; Treatment Outcome; Uterine Myomectomy

New data have emerged to support changes in first-trimester abortion practice in regard to antibiotic prophylaxis, cervical ripening, the use of manual vacuum aspiration, and pain management. This article addresses these new recommendations and reviews techniques in performing manual and electric vacuum uterine aspiration procedures before 14 weeks' gestation, including very early abortion (<7 weeks' gestation), technically difficult abortions, management of complications, and postabortal contraception. The information discussed also applies to miscarriage management.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Antibiotic Prophylaxis; Blood Loss, Surgical; Counseling; Female; Humans; Maternal Age; Medical Records; Misoprostol; Patient Safety; Practice Guidelines as Topic; Pregnancy; Pregnancy Trimester, First; Reproductive Health Services; Vacuum Curettage

The efficacy of misoprostol versus oxytocin for reducing blood loss during caesarean section remains unclear.. To conduct a meta-analysis comparing the efficacy of misoprostol with that of oxytocin in reducing blood loss during caesarean section.. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov for randomised controlled trials (RCTs) using the keywords 'misoprostol', 'oxytocin' and 'caesarean section'.. Refereed publications examining the efficacy of misoprostol and oxytocin for reducing blood loss during caesarean section.. Two of the authors independently abstracted data from original articles. A fixed-effects or random-effects model was used, depending on the heterogeneity of the data, to estimate the risk ratio (RR), risk difference (RD) or weighted mean difference (WMD) with 95% confidence intervals (95% CIs).. A total of 646 pregnant women were included in this analysis. There was a significant difference in estimated blood loss between the misoprostol and the oxytocin groups (WMD-64.09; 95% CI-119.86--8.31). However, differences in haemoglobin levels (WMD-0.04; 95% CI-0.18-0.10), additional oxytocic therapy requirements (RD .03; 95% CI -0.04-0.10) and blood transfusion requirements (RD 0.00; 95% CI-0.03-0.02) between the two groups failed to reach statistical significance. The incidence of postoperative shivering/pyrexia was significantly higher in the misoprostol group, compared with the oxytocin group (RR 3.23; 95% CI 1.41-7.39).. The results suggest that misoprostol is as effective as oxytocin for reducing blood loss during caesarean section. However, further research into treatment strategies is needed.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Humans; Misoprostol; Oxytocin; Pregnancy; Treatment Outcome

To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.. Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).. 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.. 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.

Topics: Blood Loss, Surgical; Bupivacaine; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Humans; Leiomyomatosis; Misoprostol; Oxytocin; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by significant intraoperative bleeding.. To determine whether misoprostol and tourniquet compared with tourniquet alone would significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu.. This study is an open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 μg) and B (no misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A P- value of < 0.05 was considered statistically significant.. An intention-to-treat analysis was carried out. All 63 participants (100%) and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not significantly different in both groups. The mean intraoperative blood loss in the "misoprostol group" (522.6 ± 127.91 ml) was significantly lower than in the "no-misoprostol group" (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the "misoprostol group" than in the "no-misoprostol group" (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001.. Among women receiving tourniquet during myomectomy in Enugu, the additional use of vaginal misoprostol 400 μg significantly reduced intraoperative blood loss.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Nigeria; Postoperative Hemorrhage; Uterine Myomectomy

This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (CS).. About 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values.. Both tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P < 0.001 and - 3.05 ± 1.28 vs. -3.06 ± 1.13 vs. -4.94 ± 1.82%, P < 0.001 respectively). In addition, the estimated blood loss was significantly lower in the tranexamic and misoprostol groups compared to the control group (641.6 ± 271.9 vs. 617.9 ± 207.4 vs. 1002.4 ± 340.7 ml, P < 0.001).. Both tranexamic acid and misoprostol are equally capable of reducing blood loss, but the results were significantly better compared to using oxytocin alone in high-risk patients.. Registered at www.. govon07/10/2019 with registration number NCT04117243.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Humans; Misoprostol; Oxytocin; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy; Tranexamic Acid

To assess the effect of pre-operative sublingual misoprostol on intra-operative blood loss in abdominal myomectomy as compared to placebo.. Double-blind randomised controlled pilot study. A single tertiary Gynaecology Unit in Melbourne, Australia. Women ≥ 18 years old undergoing laparoscopic or open myomectomy. Women undergoing laparoscopic or open myomectomy for symptomatic uterine leiomyomas were randomised to pre-operative sublingual 400mcg misoprostol or placebo. Intra-operative blood loss was measured via accurate record keeping of the post-operative volume in the suction canister and weighed packs, minus any irrigation fluid used.. Intraoperative blood loss in the misoprostol treatment group was 306 ml ± 281 ml, compared to 325 ± 352 ml in the placebo group; P = 0.83. Fibroid volume was a consistent predictor of intra-operative blood loss. For each 1 ml increase in fibroid volume there is an increase in blood loss by 0.26 ml (95 % CI: 0.07 - 0.46).. In this study, we found that there was no significant difference in blood loss between women who received and did not receive sublingual misoprostol before abdominal myomectomy. This is an exploratory study laying the foundation for further randomised clinical trials.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Pilot Projects; Uterine Myomectomy; Uterine Neoplasms

To determine the efficacy of intravenous tranexamic acid versus rectal misoprostol in decreasing intraoperative blood loss during caesarean section (C/S).. Randomised controlled study involving pregnant women undergoing C/S at Alex Ekwueme Federal University Teaching Hospital, Abakaliki in Nigeria.. Five hundred and fourteen women undergoing elective C/S were assigned randomly (257 patients per group) to receive either pre-operative 1000 µg rectal misoprostol or 1000mg intravenous tranexamic acid after spinal anaesthesia. Data from 248 patients were analysed in the misoprostol group, while data from 250 patients were analysed in the tranexamic acid group. Sixteen patients were excluded from analysis; nine had incompletely filled proforma, while seven were lost to follow-up.. Intraoperative blood loss.. The mean intraoperative blood loss was not significantly different between the misoprostol group and the tranexamic acid group (547 ± 183.75ml vs. 551.66 ± 21.74ml, P = 0.157). The mean difference in pack cell volume (PCV) changes was not significant between the groups (2.41±0.95% vs. 2.36±0.56%, P = 0.474). The side effects profile was similar for both groups except for shivering, which was statistically higher among the misoprostol group (RR = 0.70; 95%CI 0.40 - 0.91, P = 0.028).. Intravenous tranexamic acid was comparable to rectal misoprostol in the reduction of blood loss during C/S. Tranexamic acid could act as a good alternative to misoprostol for prophylaxis for blood loss during elective C/S.. None declared.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Humans; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Tranexamic Acid

Compare the effectiveness of administration of different doses of rectal misoprostol before cesarean section to reduce intra- and postoperative blood loss.. A double-blind randomized clinical trial including 453 term pregnant woman scheduled for elective cesarean section where participants received either 200-, 400- or 600-μg misoprostol rectally before cesarean section. Study medications were administered after catheter insertion and shortly before skin incision. Primary outcome measures were intraoperative blood loss.. The intraoperative blood loss was higher in patients who received 200-μg misoprostol (464.6 ± 143.1 mL) than those who received 400 or 600 μg, yet, no statistical difference was found between the 400- (359.3 ± 120.9 mL) and 600-μg groups (330.8 ± 133.8 mL). The incidence of side effects as fever and chills increases with increasing the dose of misoprostol.. Rectal administration of misoprostol for the prevention of post-partum hemorrhage and decreasing intraoperative blood loss during caesarian section is a good alternative to other uterotonics. Yet, the best dose to be used needs further research to be agreed upon.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Cesarean Section; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Misoprostol; Oxytocics; Postoperative Hemorrhage; Pregnancy; Treatment Outcome; Young Adult

To compare the efficacy and safety of intramyometrial vasopressin plus rectal misoprostol with intramyometrial vasopressin alone to reduce blood loss during laparoscopic myomectomy.. A randomized, single-blind, controlled trial was conducted at All India Institute of Medical Sciences, New Delhi, India. Sixty women with symptomatic leiomyoma scheduled for laparoscopic myomectomy were recruited for the study. Thirty women received intramyometrial vasopressin plus rectal misoprostol (30 min before procedure) (Group I) and 30 women received intramyometrial vasopressin alone (Group II) during laparoscopic myomectomy. The primary outcome measure was intra-operative blood loss during surgery. Secondary outcome measures included decrease in postoperative haemoglobin, ease of enucleation of myomas, duration of surgery, need for additional haemostatic measures or blood transfusion, intra- and postoperative morbidity, and duration of hospital stay.. The baseline demographic features and characteristics of leiomyomas were comparable in both groups. The mean (±standard deviation) blood loss in Group I was 139 ± 96.7 ml, which was significantly less than that for Group II (206 ± 101.2 ml) (p = 0.008). The mean postoperative haemoglobin was 11.6 ± 1.3 g/dl in Group I and 10.0 ± 1.2 g/dl in Group II (p = 0.001). Although blood loss was not clinically significant in either group, the decrease in haemoglobin was significantly higher in Group II. The mean score for ease of enucleation (surgeon-rated measure) was significantly lower in Group I (2.6 ± 1.1) compared with Group II (3.4 ± 1.1) (p = 0.029). Intra- and postoperative vital signs, duration of surgery, need for blood transfusion and postoperative morbidity were comparable in both groups.. The addition of rectal misoprostol to intramyometrial vasopressin led to a significant reduction in blood loss and decreased the postoperative drop in haemoglobin. The combination also improved the ease of enucleation of myomas.

Topics: Administration, Rectal; Adolescent; Adult; Blood Loss, Surgical; Hemostatics; Humans; Laparoscopy; Misoprostol; Oxytocics; Uterine Myomectomy; Vasopressins; Young Adult

To assess the effect of sublingual misoprostol compared to intravenous oxytocin for blood loss during cesarean delivery in women living at high altitude.. In a randomized trial, conducted in Quito, Ecuador (2800 m above sea level), 100 women received either sublingual misoprostol (400 µg) or intravenous oxytocin (10 IU).. Bleeding in the misoprostol was no different than in the oxytocin group. Shivering was reported in 66% of women in the misoprostol group.. Sublingual misoprostol might be a valid alternative to oxytocin reduce intra-operative blood loss during cesarean section in women living at high altitude.

Topics: Administration, Sublingual; Adult; Altitude; Blood Loss, Surgical; Cesarean Section; Ecuador; Female; Humans; Infusions, Intravenous; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Shivering

To determine the optimum time for misoprostol administration to minimize blood loss during and after elective cesarean delivery.. A randomized clinical trial was conducted at Mansoura University Hospital, Egypt, between January 1, 2013, and December 31, 2014. Eligible participants had full-term pregnancies, were scheduled to have a cesarean, and had normal fetal heart tracing. Patients were randomly allocated into two equal groups using computer-generated tables and sealed opaque envelopes. Misoprostol (400μg, given rectally) was given either before (group 1) or after (group 2) surgery. Patients, investigators, and data analysts were not masked to group assignment. The primary outcome was blood loss.. A total of 348 women were included (174 in each group). Blood loss was significantly lower in group 1 than in group 2 (570±240 vs 844±270mL; P<0.001). The frequency of maternal and neonatal adverse events did not differ between the groups.. Preoperative misoprostol (400μg, given rectally) reduces blood loss to a greater extent than does postoperative misoprostol during elective cesarean delivery. The frequency of complications was not affected by time of administration.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Cesarean Section; Drug Administration Schedule; Egypt; Female; Humans; Misoprostol; Oxytocics; Postoperative Hemorrhage; Postoperative Period; Postpartum Hemorrhage; Pregnancy; Preoperative Period; Young Adult

To evaluate whether a combination of misoprostol and oxytocin more effectively reduces blood loss during and after cesarean delivery than does oxytocin alone among women with known risk factors for postpartum hemorrhage (PPH).. A prospective, randomized, double-blind, placebo-controlled trial was performed at a tertiary care center in Kolkata, India, between October 2012 and December 2013. Women were eligible if they were undergoing emergency cesarean under spinal anesthesia and were at high risk for PPH. Participants were randomly assigned (1:1) to receive 400 μg misoprostol or matched placebo sublingually after delivery of the newborn using a computer-generated random number sequence (block size eight). Participants and providers were masked to assignment. All participants received 20 IU oxytocin. The primary outcomes were intraoperative and postoperative blood loss.. Both groups contained 198 women. Mean intraoperative blood loss was significantly lower in the misoprostol group (505.4±215.5 mL) than in the placebo group (587.3±201.5 mL; P<0.001). Mean postoperative blood loss was slightly lower in the misoprostol group (96.9±57.3 mL) than in the placebo group (103.4±58.4 mL; P=0.07). Shivering and pyrexia were more frequently associated with misoprostol (P<0.05 for both).. Misoprostol as an adjunct to oxytocin seemed to more effectively reduce blood loss than did oxytocin alone. Clinical Trial Registry India:CTRI/2013/05/003645.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Sublingual; Adult; Blood Loss, Surgical; Blood Volume; Cesarean Section; Double-Blind Method; Drug Therapy, Combination; Emergencies; Female; Fever; Humans; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Risk Factors; Shivering; Young Adult

Uterine leiomyomas are the most common benign tumours in women. Misoprostol, which is widely used in the treatment and prevention of postpartum haemorrhage in obstetrics, may decrease intra-operative bleeding in abdominal myomectomies when haemorrhage constitutes a challenging problem.. To assess the effect on intra-operative blood loss of using a single pre-operative dose of rectal misoprostol in abdominal myomectomy surgeries.. In a randomised double-blind placebo-controlled trial, 50 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of rectal 400 μg misoprostol (n = 25) or placebo (n = 25) 1 h before the operation. The primary outcome was intra-operative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT02061657.. Intra-operative blood loss was significantly lower in those women randomised to receive rectal misoprostol versus the placebo group (574 ± 194.8 mL vs 874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared with the placebo group (2.1 ± 0.5 g/dL).. A single pre-operative dose of rectal misoprostol (400 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Double-Blind Method; Drug Administration Schedule; Female; Humans; Leiomyoma; Middle Aged; Misoprostol; Oxytocics; Preoperative Care; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms

To investigate whether use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH).. In a randomized double-blind placebo-controlled trial at a tertiary care hospital in Kolkata, India, between March 2011 and April 2012, women (n=132) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery. The primary outcome measure was intraoperative blood loss was. The secondary outcomes were postoperative drop in hemoglobin, need for blood transfusion, and incidence of adverse effects.. The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (356 mL vs 435 mL; P=0.049). The mean postoperative hemoglobin concentration was higher (10.5 g/dL vs 9.5 g/dL; P<0.001) and the postoperative drop in hemoglobin was smaller (1.1g/dL vs 1.9 g/dL; P=0.004) in the misoprostol group than in the placebo group. No significant adverse effects occurred in either group.. The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects. Clinical Trial Registry India (www.ctri.nic.in): CTRI/2011/091/000216.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Female; Follow-Up Studies; Hemoglobins; Humans; Hysterectomy; India; Leiomyoma; Middle Aged; Misoprostol; Ovariectomy; Oxytocics; Salpingectomy; Tertiary Care Centers; Treatment Outcome; Uterine Neoplasms

To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies.. Prospective, randomized, double-blind, controlled study.. University of the West Indies and Andrews Memorial Hospital.. Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy.. Abdominal myomectomies on patients with symptomatic uterine fibroids.. Perioperative blood loss and febrile morbidity.. There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids.. We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone.. NCT01700478.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Drug Therapy, Combination; Female; Hemostatic Techniques; Hemostatics; Humans; Jamaica; Leiomyoma; Misoprostol; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

The present study was undertaken to compare the efficacy of isosorbide mononitrate (IMN) and misoprostol for cervical ripening in termination of pregnancy between 8 and 12 weeks.. This prospective randomized single blind study enrolled 40 women with singleton pregnancy seeking surgical termination of pregnancy between 8 and 12 weeks of gestation. They were divided into two groups--group I received IMN 40 mg while group II received misoprostol 40 mg vaginally, 3 h prior to suction and evacuation. All women were monitored for effects of cervical ripening and adverse effects.. The mean sizes of dilators that could be negotiated without any resistance was 5.9 ± 1.33 in group I and 8.6 ± 0.94 in group II (p < 0.001, 95% CI 0.58, 0.41). The mean dilator sizes at which resistance was first encountered was 6.9 ± 1.37 in group I and 9.9 ± 1.23 in group II (p < 0.001, 95% CI 0.60, 0.54). The mean blood loss was 61.5 ± 13.86 ml in group I and 36.25 ± 12.80 ml in group II (p < 0.001, 95% CI 6.07, 5.63). Headache was the most common adverse effect seen with IMN use.. The results show that IMN has a definite role and better safety profile than misoprostol in first trimester cervical ripening, although misoprostol is more effective and causes less blood loss.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Blood Loss, Surgical; Cervical Ripening; Female; Hospitals, Teaching; Humans; India; Isosorbide Dinitrate; Labor Stage, First; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Single-Blind Method; Treatment Outcome; Vacuum Curettage; Young Adult

To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10 weeks of pregnancy.. A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3 hours before MVA or EVA, respectively. Group III and IV received 400 μg of vaginal misoprostol 3 hours before MVA or EVA, respectively.. Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo (P>0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions (P=0.40), and the least operative blood loss, operating time, and need for cervical dilation (P<0.05). Overall complications and adverse effects were similar in all groups (P>0.05).. For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3 hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10 weeks of gestation.. CTRI/2009/091/000008.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Blood Loss, Surgical; Cervical Ripening; Double-Blind Method; Female; Follow-Up Studies; Humans; Misoprostol; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Vacuum Curettage

The aim of this study was to compare the effectiveness and safety of sublingual misoprostol with i.v. oxytocin infusion administered after delivery in reducing blood loss at cesarean section in Nigeria.. One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia in Nigeria were randomly allocated to receive either misoprostol 400 µg sublingually or i.v. infusion of 20 units oxytocin soon after delivery of the baby. Estimated blood loss at surgery and within the first 4 h post-operation were measured in both groups.. No significant difference was found in mean blood loss between the oxytocin and misoprostol groups. Similarly, no significant difference occurred between preoperative and postoperative hematocrit levels in both groups. The need for additional oxytocin was similar in both groups. There was significantly less blood loss in the first 4 h after surgery in the misoprostol group than in the oxytocin group (58.2 ± 20.7 vs 80.5 ± 26.8; P-value = 0.02). The incidence of adverse effects like shivering/pyrexia was significantly higher in the misoprostol group than in the oxytocin group (27/50 vs 1/50, P < 0.001).. Sublingual misoprostol was as effective as i.v. oxytocin infusion in reducing blood loss at cesarean section. It offers several advantages over oxytocin, including long shelf life, stability at room temperature, and oral administration, which make it a suitable uterotonic agent in low-resource areas.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Cesarean Section; Double-Blind Method; Female; Humans; Infusions, Intravenous; Misoprostol; Nigeria; Oxytocics; Oxytocin; Pregnancy

We performed a randomized clinical trial to estimate whether preoperative use of misoprostol may reduce intraoperative blood loss of patients treated by minimally invasive surgery (MIS), such as laparoscopic (LM) or laparoscopically assisted myomectomy (LAM).. Sixty-seven menstruating patients with three or less myomas of a maximum diameter of 90 mm, scheduled for MIS, were randomly allocated to receive a preoperative single dose of intravaginal misoprostol or placebo. Sixty-four patients remained in the final analysis: 30 in the misoprostol (I) and 34 in the placebo group (II). Estimated blood loss (EBL), decline of postoperative hemoglobin (Hb) and side-effects of administered agent were the outcomes of main interest.. The EBL was significantly higher in the placebo versus misoprostol group (217 +/- 74 vs 126 +/- 41, respectively). Similarly, the decline of postoperative Hb was significantly higher in group II (1.6 +/- 0.43) compared to group I (1 +/- 0.33). The operative time was comparable in both groups, while the rate of side-effects was similar between groups.. The preoperative use of misoprostol in patients with uterine fibroids managed by minimally invasive surgery significantly reduces intraoperative blood loss. Misoprostol might be useful for the prevention of postoperative anemia in more extended minimal invasive interventions, such as myomectomy of large fibroids or laparoscopic hysterectomy.

Topics: Administration, Intravaginal; Adult; Blood Loss, Surgical; Chi-Square Distribution; Female; Hemoglobins; Humans; Laparoscopy; Leiomyoma; Misoprostol; Oxytocics; Pilot Projects; Prospective Studies; Uterine Neoplasms

To investigate the effectiveness of a single pre-operative dose of sublingual misoprostol on reducing blood loss in abdominal hysterectomies performed for symptomatic uterine leiomyomas.. A cohort of 64 women undergoing total abdominal hysterectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of sublingual 400 mcg misoprostol (n=32) or placebo containing 20mg vitamin B(6) (n=32) 30 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were requirement for blood transfusion, change in haemoglobin level after operation, and the incidence of side effects.. Women who had misoprostol were found to have similar operative blood loss to those who had placebo (570.9 ± 361.3 ml versus 521.4 ± 297.4 ml, for misoprostol and placebo group respectively; P=0.803). This study with a sample size of 64 was sufficient to have 80% power at the 5% level of significance to detect a reduction of blood loss greater than or equal to 30%. There were no observed differences in the need for post-operative blood transfusion (25% versus 15.6%, for misoprostol and placebo group respectively; P=0.536), the change in haemoglobin level after the operation, and the side effects profiles between the two groups.. A single pre-operative dose of sublingual misoprostol is not effective in reducing intra-operative blood loss and need for post-operative blood transfusion after total abdominal hysterectomies for symptomatic uterine leiomyomas.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Double-Blind Method; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Misoprostol; Oxytocics; Pilot Projects; Preoperative Care; Uterine Neoplasms

To compare the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery.. In this prospective, randomized, double-blind trial, 200 women undergoing cesarean delivery who did not have risk factors for postpartum hemorrhage were randomly allocated to receive either 800 microg of rectal misoprostol at the time of peritoneal incision or an intravenous infusion of oxytocin after delivery of the neonate. Primary outcome measures were estimated amount of intraoperative and postoperative (8 hours) blood loss and changes in hemoglobin levels 24 hours after delivery.. A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group (503 vs 592 mL, P=0.003 and 74 vs 114 mL, P=0.045, respectively). The incidence of shivering was higher in the misoprostol group (8.3% vs 1.1%, P=0.018; RR 7.83; 95% confidence interval, 0.99-61.42).. Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery.. CTRI/2009/091/000075.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Cesarean Section; Double-Blind Method; Female; Humans; Infusions, Intravenous; Misoprostol; Oxytocics; Oxytocin; Postoperative Complications; Pregnancy; Prospective Studies; Uterine Inertia; Young Adult

To investigate the effectiveness of uterotonics misoprostol and oxytocin on reducing blood loss during laparoscopy-assisted vaginal hysterectomy (LAVH).. Randomised, double-blind placebo-controlled trial.. University hospital.. One hundred and seventy-three women underwent LAVH for symptomatic uterine myomas and were randomly allocated to uterotonics (n = 91) or placebo (n = 82).. Women underwent LAVH for symptomatic uterine myomas and were randomly assigned to receive either rectal misoprostol (400 microg) and intravenous oxytocin (10 IU/hour) or placebo during LAVH. Parameters related to surgical outcome were compared.. The main outcome measure was intra-operative blood loss.. Patient characteristics and indications for LAVH were similar in both groups. Mean [SD] for all continuous data estimated weight of blood loss (198.1 [123.2] vs 396 [337.6] g; P < 0.0001), mean operation time (106.2 [39.4] vs 116.6 [34.6] minutes; P = 0.02), mean change in haemoglobin (1.5 [1.0] vs 1.9 [1.2] g/dL; P = 0.02) and haematocrit levels (4.8 [2.9]% vs 5.8 [3.6]%; P = 0.04) and mean hospitalisation period (3.3 [0.8] vs 3.9 [1.1] days; P < 0.0001), which were significantly less in the group given rectal misoprostol and intravenous oxytocin than in the placebo group, respectively. There was no significant difference in complications and side effects between the two groups (P > 0.05).. Combined rectal misoprostol and intravenous oxytocin is a feasible and effective method of reducing blood loss and operation time in LAVH.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Drug Therapy, Combination; Female; Humans; Hysterectomy, Vaginal; Infusions, Intravenous; Laparoscopy; Leiomyoma; Length of Stay; Middle Aged; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome; Uterine Neoplasms

Results from small-scale randomized studies on the effectiveness of different preparations of nitric oxide donors in cervical priming before first trimester termination of pregnancies are not consistent. We compared sodium nitroprusside gel to misoprostol, the standard agent for cervical priming in this randomized double-blinded controlled trial.. Two hundred pregnant patients between 8 to 12 weeks admitted for surgical termination of pregnancy were recruited. They were randomized into either 400 microg vaginal misoprostol and intracervical placebo gel, or 10 mg intracervical sodium nitroprusside gel and placebo tablets 3 h before the procedure. The baseline cervical dilatation and cumulative force required to dilate the cervix from 4 to 9 mm were measured with a tonometer. Blood pressure was measured and side effects were assessed.. The cumulative force to dilate the cervix from 4 to 9 mm was significantly higher in the sodium nitroprusside group, and the difference remained when a sub-group analysis was performed according to parity. Baseline cervical dilatation, duration of operation and operative blood loss were all in favour of misoprostol. Transient drop in blood pressure was observed after sodium nitroprusside treatment.. Intracervical sodium nitroprusside is not as effective as misoprostol in cervical priming.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Blood Loss, Surgical; Blood Pressure; Cervix Uteri; Dilatation; Double-Blind Method; Female; Gels; Humans; Misoprostol; Nitroprusside; Pregnancy; Pregnancy Trimester, First; Time Factors

To investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies.. Placebo-controlled randomized prospective study.. Department of obstetrics and gynecology in a university hospital.. Twenty-five women with symptomatic uterine leiomyomas.. Among patients undergoing abdominal myomectomies, an hour before the operation women in the study group (n = 13) were given a single dose of vaginal misoprostol (400 microg); those in the control group (n = 12) were given placebo.. Intraoperative blood loss, duration of operation, duration of postoperative hospitalization, and the need for blood transfusion were compared between the control and study groups.. Blood loss, operation time, and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol. No difference was observed among patients in terms of the time of hospitalization.. A single preoperative dose of vaginal misoprostol is a simple, reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies.

Topics: Administration, Intravaginal; Adult; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Leiomyoma; Misoprostol; Prospective Studies; Uterine Neoplasms

Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent, has been reported to be useful in the prevention and treatment of postpartum hemorrhage by several investigators but its use during cesarean section has not been described. The objective of this study was to randomly compare the effectiveness of oral misoprostol with intravenous syntocinon on blood loss during elective cesarean sections under regional anesthesia.. Sixty pregnant women were randomized either to receive misoprostol 400 micrograms orally or syntocinon 10 IU intravenously during cesarean section. The primary outcome measure was intra-operative blood loss as estimated by physicians, and by values of preoperative and postoperative hemoglobin concentration and hematocrit. Demographic characteristics of the subjects and outcomes were compared using chi-square test for categorical and two-sample t-test for continuous data.. Baseline characteristics in terms of age, body weight, parity, gestational age and indications for cesarean section were similar in both groups. The estimated blood loss was 545 ml (CI 476-614) in misoprostol group and 533 ml (CI 427-639) in syntocinon group (p = 0.85). Differences in preoperative and postoperative hemoglobin and hematocrit values were also similar in both groups. Two women in the misoprostol group and three in the syntocinon group (p=0.64) required additional oxytocics. One patient in each group required blood transfusion. No serious side effects were noted in either group.. Oral misoprostol appears to be safe and as effective as intravenous syntocinon in reduction of intra-operative blood loss during elective cesarean section under regional anesthesia and merits further investigation.

Topics: Administration, Oral; Adult; Blood Loss, Surgical; Cesarean Section; Female; Humans; Injections, Intravenous; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome

Our purpose was to compare the efficacy, safety, and adverse effects of intra-amniotically administered (15S)-15-methyl-prostaglandin F(2alpha) and intravaginally administered misoprostol for second-trimester uterine evacuation.. Fifty-one patients were randomly assigned to receive either a single 2.5-mg intra-amniotic injection of (15S)-15-methyl-prostaglandin F(2)(alpha) (n = 26) or two 200-microg intravaginal doses of misoprostol (n = 25) at 12-hour intervals. The primary outcome measured was evacuation of the uterus within 24 hours.. The mean time from initiation of termination to uterine evacuation was less in the prostaglandin group than in the misoprostol group (17.5 +/- 8.6 hours vs 22.3 +/- 12.5 hours), but this was not statistically significant (P >.05). The rate of successful fetal evacuation at 24 hours was significantly higher in the prostaglandin group than in the misoprostol group (88% vs 60%, P =.02). The complete-abortion rate and the incidence of adverse effects were similar in both groups.. The use of an intra-amniotic injection of (15S)-15-methyl-prostaglandin F(2alpha) for midtrimester pregnancy termination is safe and is associated with a greater number of successful uterine evacuations within 24 hours, without an increase in adverse effects, than intravaginal administration of misoprostol.

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Eugenic; Administration, Intravaginal; Adult; Amnion; Blood Loss, Surgical; Carboprost; Dose-Response Relationship, Drug; Female; Gestational Age; Humans; Injections; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Time Factors; Treatment Outcome; Vacuum Curettage

We compared bleeding patterns following early mifepristone-misoprostol abortion with those following early surgical abortions ( < or = 56 days gestation LMP). We analyzed women's reports of their bleeding and clinical measures of blood loss, and modeled the relationships between different bleeding measures and indicators of success and satisfaction.. Using data from a multicenter trial held in China, Cuba and India, we fit bivariate and multivariate models to analyze bleeding patterns, controlling for a range of demographic, experiential and medical factors (n = 1373).. Medical abortion patients perceived their bleeding to be heavier than did the surgical patients; however, there were few statistically significant differences in clinical measures of blood loss between the two groups, and blood loss rarely represented a medical problem. Nationality, far more than actual levels of bleeding, influenced women's impressions about blood loss. Although medical abortion patients saw their bleeding as heavier than did the surgical patients, their perceptions of heavier bleeding did not prevent them from having higher satisfaction levels. One exception was that if bleeding exceeded prior expectations, women with the medical method were more likely to be dissatisfied. Pain and cramps, which often accompanied bleeding, were an independently significant factor in predicting satisfaction with the method.. In order for women to know what to expect with medical abortion, they must be informed beforehand about the level of bleeding that generally accompanies the procedure vs. excessive bleeding that would signal a clinical problem.

Topics: Abortifacient Agents; Abortion, Therapeutic; Adult; Blood Loss, Surgical; Cuba; Feasibility Studies; Female; Humans; India; Logistic Models; Mifepristone; Misoprostol; Patient Satisfaction; Pregnancy; Software; Uterine Hemorrhage

To determine the incidence of gastrointestinal (GI) tract bleeding in dogs undergoing spinal surgery with adjunct corticosteroid treatment, and to determine the protective efficacy of cimetidine, sucralfate, and misoprostol against such bleeding in these dogs.. 40 dogs that underwent spinal surgery.. Myelography and surgery were performed on the first or second day of hospitalization. Methylprednisolone sodium succinate was given at a dosage of 30 mg/kg of body weight prior to myelography, followed by a second full or half dose 2 to 4 hours later at clinician discretion. Spinal surgery was performed in conventional manner, postoperative administration of analgesics was done, and dogs were fed a diet lacking red meat. Dogs were assigned at random to 1 of the 3 treatment groups or to the control group. Dogs of the treatment groups received cimetidine, sucralfate, or misoprostol. Physical examination and determination of PCV and serum total protein values were performed daily. A fecal sample was examined daily for gross and occult blood.. 36 of 40 dogs had GI tract bleeding during a hospitalization period of 3 to 6 days. There was no significant difference in development of bleeding between the control group and any of the treatment groups.. Gastrointestinal tract bleeding occurred in 90% of dogs undergoing spinal surgery combined with administration of methylprednisilone sodium succinate, a higher rate than that found in previous studies. This bleeding was not life-threatening. Prophylactic benefit from any of the GI protectants tested was not found.

Topics: Adrenal Cortex Hormones; Animals; Anti-Inflammatory Agents; Anti-Ulcer Agents; Blood Loss, Surgical; Body Weight; Cimetidine; Dog Diseases; Dogs; Dose-Response Relationship, Drug; Gastrointestinal Hemorrhage; Incidence; Methylprednisolone Hemisuccinate; Misoprostol; Myelography; Occult Blood; Spine; Sucralfate

Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy.. Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3).. Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events.. Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Laparoscopy; Misoprostol; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Cesarean section is a common surgery in women. Different drugs are used to control its bleeding. This study compared the effect of using rectal misoprostol before and after surgery on the amount of post-cesarean bleeding.. A number of 120 women who were admitted to our hospital because of elective cesarean section entered this clinical trial. They were divided into two groups. The first (before surgery) group received 400μg of rectal misoprostol before the cesarean section and the second (after surgery) group after the surgery. The amount of bleeding was measured in both groups. The data were recorded and analyzed.. Their mean of age was 29.1±6.1 years old. The mean of blood loss volume was 283±147mL in the before-surgery group and 294±108mL in the after-surgery group (P=0.6). There was no significant difference in the level of post-operation hemoglobin between the two groups. However, the frequency of need for additional uterotonics was 47% in the first group and 85% in the second group (P<0.001).. There seems to be no significant difference in administering rectal misoprostol before or after the surgery, but the need for additional uterotonics is reduced if it is used before the surgery.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Cesarean Section; Female; Hemoglobins; Humans; Misoprostol; Oxytocics; Postpartum Hemorrhage; Pregnancy; Time Factors

Excessive bleeding during and after caesarean section is a major cause of maternal morbidity and mortality, especially in low resource countries. This study evaluates the effect of intrauterine misoprostol with oxytocin in comparison with oxytocin alone on blood loss during caesarean section. A retrospective data analysis of 160 women who underwent lower segment caesarean section was conducted. Eighty-five out of 160 (53%) women received tablet misoprostol 800 µg by intrauterine route after delivery of a baby in addition to routine oxytocin infusion (group A), while 75 women (47%) received only oxytocin (group B). Blood loss, Haemoglobin (Hb) difference (pre-operative Hb - post-operative Hb) and need of any other oxytocic were compared in both the groups. Demographic variables such as mean age, parity, and an indication of caesarean section were comparable in both the groups. Mean blood loss during caesarean section was lower in group A (680 ± 202 mL) than group B (740 ± 228 mL) (

Topics: Adult; Blood Loss, Surgical; Cesarean Section; Female; Humans; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Uterus

Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Blood Loss, Surgical; Family Planning Services; Female; Gestational Age; Gynecology; Hemostatics; Humans; Methylergonovine; Misoprostol; Obstetrics; Oxytocics; Practice Patterns, Physicians'; Pregnancy; Surveys and Questionnaires; United States; Uterine Hemorrhage; Vasopressins

Topics: Administration, Sublingual; Blood Loss, Surgical; Drug Administration Schedule; Female; Humans; Hysterectomy; Middle Aged; Misoprostol; Solubility; Tablets; Time Factors

Topics: Administration, Sublingual; Awards and Prizes; Blood Loss, Surgical; Female; Humans; Hysterectomy; Misoprostol; Oxytocics; Periodicals as Topic; Publishing

Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome.. To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operation.. A prospective study.. The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400 μg-misoprostol versus oxytocin: 1.88 versus 3.04; p = 0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol.. Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol.

Topics: Administration, Sublingual; Adult; Blood Loss, Surgical; Cesarean Section; Female; Hematocrit; Humans; Injections, Intravenous; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Preoperative Care; Prospective Studies; Treatment Outcome

Intraoperative blood loss is a concern in the surgical treatment of myomatous uteri. Misoprostol causes the myometrium and isolated uterine arteries to contract and has blood-saving effects in myomectomy.. To assess the efficacy of rectal misoprostol in reducing haemorrhage during laparoscopy-assisted vaginal hysterectomy (LAVH).. Retrospective case-control study. Women who had undergone LAVH for leiomyoma were enrolled (n=117). Forty-nine women who used 400 μg of misoprostol rectally 1 h before LAVH were compared with 68 women who did not. The surgical outcomes were compared statistically with Mann-Whitney rank sum test, χ(2) test, or Fisher's exact test.. The demographic variables were similarly distributed in both groups. There were no significant differences in the estimated blood loss, reduction in haemoglobin, operation time, or uterine weight between the two groups (P>0.05). The rates of operative complications (4.1 vs 10.3% for the misoprostol and control groups, respectively, P=0.21) were not different. There was no febrile morbidity (>38°C) within 24 h of the misoprostol insertion.. These data do not support the use of rectal misoprostol to reduce blood loss during LAVH. The pharmacoclinical effects of misoprostol in the uterus should be clarified.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Middle Aged; Misoprostol; Retrospective Studies; Treatment Outcome; Uterine Hemorrhage; Uterine Neoplasms

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Blood Loss, Surgical; Female; Gestational Age; Humans; Misoprostol

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Preoperative Care; Uterine Neoplasms

Topics: Administration, Intravaginal; Blood Loss, Surgical; Female; Humans; Leiomyoma; Misoprostol; Preoperative Care; Time Factors; Uterine Neoplasms