Use of misoprostol in myomectomy: a systematic review and meta-analysis

Introduction Misoprostol, a prostaglandin derivative, reduces blood flow to uterus, facilitating every surgical operation on myometrium. Method PubMed, Scopus and Cochrane databases were systematically searched and five studies met the inclusion criteria for our meta-analysis. Results In total, 283 patients were included. The intention to treat population included 142 patients. The mean age of the patients was 34 years old. The vaginal route of administration was preferred in 117 out of 142 patients and the rectal route in 25 patients. Three studies were included in the analysis regarding duration of operation, estimated blood loss, preoperative/postoperative hemoglobin, transfusions needed and febrile morbidity. No significant difference was observed between vaginal suppository and placebo group concerning the duration of operation, the fall of preoperative hemoglobin, transfusions needed and the febrile morbidity. Regarding the estimated blood loss, the mean difference observed between the misoprostol and placebo groups was -148.55 mL per operation (95 % CI, -233.10 to -64), p < 0.001. As far as the postoperative Hgb, the misoprostol group presented significantly smaller reduction, 0.68 gr/dL per operation (95 % CI, 0.38-0.97), p < 0.001. Conclusion Easy to use, minor or no side effects, and good clinical outcomes are the properties that render misoprostol useful in the realization myomectomy independently of the surgical technique applied.