INTRAVENOUS OXYTOCIN VERSUS PERI-CERVICAL TOURNIQUET TO DECREASE BLOOD LOSS IN TRANSABDOMINAL MYOMECTOMY: A RANDOMIZED CONTROLLED TRIAL
Ahmed Hussein Amin1, Hossam Abdou2
Departments of Obstetrics and Gynecology, 1Faculty of Medicine, Cairo University, and 2Helwan University, Egypt
Objective: The aim of the current study was to compare between the effect of medical (pre-operative intravenous oxytocin infusion) and non-medical (peri-cervical mechanical tourniquet) interventions regarding their efficacy to decrease blood loss in abdominal myomectomy. Study Design: A prospective randomized controlled clinical trial. Patients and Methods: The study was conducted in obstetrics and gynecology hospital, faculty of medicine, Cairo University, Egypt in the period from January 2016 till December 2016. It included 140 women seeking treatment for symptomatic leiomyomas, and scheduled for abdominal myomectomy. Patients were randomly assigned into two groups: group A who received intravenous oxytocin infusion intraoperatively and group B in whom pericervical tourniquet was applied. The primary outcome was intra-operative blood loss while the secondary outcomes were the need for blood transfusion, difference between preoperative and postoperative hemoglobin and hematocrit, operative time, length of hospital stay, and postoperative fever. Results: baseline characteristic of study participants were similar between both groups with no statistically significant differences between them. There was a statistically significant difference between both groups regarding intra-operative blood loss (493.9±125.2 in oxytocin group 408.3±94.3 in tourniquet group; p=0.027). Postoperative hemoglobin and hematocrit were significantly higher in the tourniquet group (10.92±0.92 &29.76±2.77 respectively) than the oxytocin group (9.06±0.78 &23.74±2.99 respectively; p=<0.001). other outcomes as hospital stay, the operative time, postoperative fever and wound infection did not show statistically significant differences in both groups. Conclusion: peri-cervical Tourniquet is more effective than oxytocin infusion in decreasing blood loss during myomectomy operation besides reducing the need for blood transfusion. The tourniquet is a cheap method and should be used in all myomectomy operations when possible.