POMMS: Pre-operative misoprostol in myomectomy surgery: A randomised controlled pilot study

Evaluation of the effect of preoperative rectal misoprostol use on the postoperative outcomes of hysteroscopic myomectomy

“…The heterogeneities of studies in terms of factors such as misoprostol administration site or timing, dosage, number of doses, and the timing or techniques used for bleeding evaluation may explain the differences between reported findings. On the other hand, in this study, we found that fibroid size was an independent predictor of hemoglobin reduction, which supports some results in the literature 14,26 . In women with large fibroids who will undergo hysteroscopic myomectomy, it may be beneficial to take other precautions in addition to misoprostol treatment in the preoperative period in order to prevent postoperative hemoglobin decrease in women with large fibroids, and it may be necessary to assess the utility of GnRH‐a treatment—which is effective in reducing myoma size 27 …”

“…In another meta‐analysis, vaginal misoprostol recipients were reported experience lower levels of blood loss and hemoglobin decrease 11 . On the other hand, some studies report no relationship between blood loss and preoperative misoprostol use in women undergoing myomectomy 24–26 . Similar to these latter results, we found that misoprostol use was not a predictor of hemoglobin reduction in women who underwent hysteroscopy myomectomy.…”

“…11 On the other hand, some studies report no relationship between blood loss and preoperative misoprostol use in women undergoing myomectomy. [24][25][26] Similar to these latter results, we found that misoprostol use was not a predictor of hemoglobin reduction in women who underwent hysteroscopy myomectomy. It is possible that the bleedingpreventive effects of misoprostol may be limited by the number or absolute size of fibroids/myomas in some patients.…”

“…On the other hand, in this study, we found that fibroid size was an independent predictor of hemoglobin reduction, which supports some results in the literature. 14,26 In women with large fibroids who will undergo hysteroscopic myomectomy, it may be beneficial to take other precautions in addition to misoprostol treatment in the preoperative period in order to prevent postoperative hemoglobin decrease in women with large fibroids, and it may be necessary to assess the utility of GnRH-a treatment-which is effective in reducing myoma size. 27 In patients undergoing hysteroscopy, pain is mainly produced by cervical dilation, passage of the hysteroscope through the cervical canal, and stretching of the uterus with fluid.…”