A systematic review of randomized controlled trials to reduce hemorrhage during myomectomy for uterine fibroids

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