Comparison of the Intraoperative Outcomes of Intrauterine Instillation of Epsilon-Aminocaproic Acid and Intravenous Oxytocin in Hysteroscopy Surgeries

Objectives: As the technique of choice, hysteroscopy can be used in visualizing and treating intrauterine pathologies such as polyps, septa, fibroids and endometrial hyperplasia. The best visualization, however, is attained when the endometrium is flat or atrophic; or a pre-existing active bleeding is minimal or suspended during hysteroscopy. Both epsilon-aminocaproic acid (EACA) and oxytocin have been found effective against active bleeding. The present work aimed to compare the efficacy and safety of intrauterine EACA and intravenous oxytocin in the management of intractable uterine bleeding in candidates of operative hysteroscopy. Materials and Methods: In this single-center, observer-blinded clinical trial, 144 candidates of operative hysteroscopy with intractable moderate uterine bleeding were randomized in two groups, receiving either intrauterine instillation of EACA (2 g in 1 L of 5% dextrose serum, n = 72) or intravenous oxytocin (10 IU/L, n = 72). The operator graded the severity of intraoperational bleeding (I = no to V = most severe). Serum hematocrit and hemoglobin changes, intra-and post-operational complications, the mean operative time, and the mean volume of the employed media were also recorded and compared between the two groups. Results: The two groups were comparable in terms of age, gravidity and parity. Grades I, II and III of intraoperational bleeding were reported in 79.2%, 18.1% and 2.8% of cases in the EACA group, and 18.2%, 65.3% and 16.7% of the cases in the oxytocin group, respectively (P < 0.001). While the two groups were also comparable in terms of serum hematocrit and hemoglobin changes, intra-and post-operation complications (none in both groups) and the mean volume of the media intraoperatively, the mean operative time was significantly shorter in patients who received intrauterine instillation of EACA (10.28 +/- 3.24 minutes vs. 11.81 +/- 4.62 minutes, P = 0.02). Conclusion: Owing to less severe intraoperative hemorrhage and shorter duration of operation in the group who received intrauterine instillation of EACA than those with intravenous injection of oxytocin, we recommend the intrauterine EACA in managing intractable uterine bleeding in candidates of hysteroscopy.