Oxytocin and combined administration of tranexamic acid and ethamsylate did not yield any significant improvement in the management of intraoperative bleeding during abdominal myomectomy for uterine fibroids in this study.
Myomectomy is the treatment of choice in the management of uterine fibroids; however, myomectomy-related hemorrhage is a significant surgical complication.
This randomized-controlled trial published in the journal BMC Women’s Health compared the safety and efficacy of oxytocin versus combined tranexamic acid (TXA) and ethamsylate in the management of intraoperative bleeding during myomectomy.
A total of 180 female patients were enrolled in this trial and randomly allocated to normal saline (110 ml), TXA (1 g) 250 mg and ethamsylate (250 mg), and oxytocin (30 IU) groups. The three groups differed significantly on the basis of age. Approximately 47.2% of the patients underwent a previous cesarean section (CS). There were non-significant differences across the three groups based on body mass index (BMI), CS indications, previous CS, parity, hematocrit, and hemoglobin values.
Comparative Analysis of Blood Loss Reduction Strategies in Abdominal Myomectomy
There was no significant difference across the three groups based on the levels of blood loss following abdominal myomectomy. The blood loss levels of saline, combined TXA and ethamsylate, and oxytocin were 646.67 ± 168.92 ml, 630.72 ± 145.83 ml, and 666.25 ± 183.03 ml, respectively. Both oxytocin and combined TXA and ethamsylate demonstrated a significant reduction in the hemoglobin and hematocrit values based on the paired t-test results.
Hemostatic Agents and Postoperative Suction Bottle and Towel Weight
Similarly, the paired t-test indicated that suction bottle weight and towel weight increased in the study groups. The postoperative towel weight was 509.25 ± 112.2 mg, 496.87 ± 102.57 mg, and 505.72 ± 108.84 mg for oxytocin, combined TXA and ethamsylate, and saline, respectively. The differences in these primary and secondary outcomes were determined to be non-significant upon application of the one-way ANOVA.
Comparison of Outcomes in Three Treatment Groups After Hysterectomy
After applying the ANOVA test, there were non-significant differences across the three groups based on the hospital stay, postoperative parenteral iron transfusion, operative time, postoperative fever, and blood transfusion. None of the patients from the three groups required a hysterectomy.
Abdou, A. M., Eldesouky, E., Farag, E., Mohammed, A., Abdelaziz, D. F. M., Shaaban, A., Ellaban, M., Elhalim, A. E. M. A., Elsror, A. G. A., Marai, A. A. E., Abdel-Hakam, F., Abd-ElGawad, M., Elrashedy, A. A., Abdelmonem, H., Kamel, M. A., Afiffi, I. K., Elsayed, H. G. A., Abdelhamed, S. A., Bosilah, A. H., & Marie, H. (2023). Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial. BMC women’s health, 23(1), 398. https://doi.org/10.1186/s12905-023-02549-z