Our Summary

This research paper looked at which medications were most effective in reducing blood loss during a specific surgical procedure called a myomectomy. This procedure is done to remove uterine fibroids, either through a traditional open surgery or a minimally invasive procedure.

The authors looked at 26 different studies, which included 1627 patients in total. They found that several medications, including oxytocin, ornipressin, misoprostol, bupivacaine plus epinephrine, and vasopressin, helped reduce blood loss during minimally invasive procedures. However, they noted that the quality of this evidence was low.

The top two medications for reducing blood loss in minimally invasive procedures were oxytocin and ornipressin.

For open surgeries, a combination of vasopressin and misoprostol was found to be the most effective. Other helpful medications included oxytocin, tranexamic acid (TXA), and misoprostol. Again, the quality of the evidence was low.

In conclusion, the paper suggests that certain medications, particularly oxytocin, can help reduce blood loss during these surgeries. However, more research may be needed due to the low quality of the existing evidence.

FAQs

  1. What is a myomectomy and why is it performed?
  2. Which medications were found to be most effective in reducing blood loss during a myomectomy?
  3. What further research is suggested by the paper due to the low quality of the existing evidence?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss with them the potential benefits of using certain medications, such as oxytocin, to help reduce blood loss during the procedure. It is important for the patient to have a thorough discussion with their doctor about the potential risks and benefits of using these medications before undergoing the surgery.

Suitable For

Patients who are typically recommended for a myomectomy include those who have symptomatic uterine fibroids that are causing heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, or infertility. Women who wish to preserve their fertility or avoid a hysterectomy may also be good candidates for a myomectomy. Additionally, patients who are not candidates for other fibroid treatment options, such as uterine artery embolization or focused ultrasound surgery, may be recommended for a myomectomy. It is important for patients to discuss their individual circumstances and treatment options with their healthcare provider to determine if a myomectomy is the best course of action for them.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of uterine fibroids, such as heavy menstrual bleeding, pelvic pain, and frequent urination.
  2. Patient consults with a healthcare provider who recommends a myomectomy as a treatment option.
  3. Patient undergoes pre-operative tests and evaluations to determine the best approach for the surgery.

After myomectomy:

  1. Patient undergoes the myomectomy procedure, either through traditional open surgery or minimally invasive surgery.
  2. Patient is monitored in the recovery room and may stay in the hospital for a few days for observation.
  3. Patient may experience pain and discomfort in the days following the surgery and will be prescribed pain medications.
  4. Patient will have follow-up appointments with their healthcare provider to monitor their recovery and address any concerns.
  5. Patient may experience improvements in their symptoms, such as decreased menstrual bleeding and relief from pelvic pain, following the myomectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What type of myomectomy procedure do you recommend for me, and why?
  2. What are the potential risks and complications associated with myomectomy surgery?
  3. Will I need to take any medications before or after the surgery, and if so, what are they for?
  4. How will you monitor and manage my pain during and after the surgery?
  5. Are there any specific medications that can help reduce blood loss during myomectomy, and if so, will you be using them?
  6. How long is the recovery period after myomectomy surgery, and what can I expect in terms of physical activity and restrictions?
  7. What is the likelihood of fibroid recurrence after myomectomy, and are there any additional treatments or preventive measures I should consider?
  8. Will I need to undergo any follow-up procedures or tests after myomectomy surgery?
  9. How experienced are you in performing myomectomy procedures, and what is your success rate with this surgery?
  10. Are there any lifestyle changes or dietary recommendations I should follow to promote healing and prevent future fibroids?

Reference

Authors: Samy A, Raslan AN, Talaat B, El Lithy A, El Sharkawy M, Sharaf MF, Hussein AH, Amin AH, Ibrahim AM, Elsherbiny WS, Soliman HH, Metwally AA. Journal: Fertil Steril. 2020 Jan;113(1):224-233.e6. doi: 10.1016/j.fertnstert.2019.09.016. Epub 2019 Nov 18. PMID: 31753311