Minimizing Blood Loss
John C. Petrozza in Uterine Fibroids, 2020
There are several prostaglandin-derived medications that can minimize intraoperative blood loss. They act by causing vasoconstriction of the uterine arteries. They also cause myometrial contraction, which in turn causes contraction of vascular structures in the uterus, thus decreasing blood flow to myomas [6]. These medications, like misoprostol and dinoprostone, are easy to administer and can be given on the day of surgery in the preoperative holding area. Misoprostol has been well studied due to its common use in obstetrics and is considered a safe medication with few side effects. Misoprostol can be administered orally, buccally, sublingual, rectally and vaginally. The mode of delivery with the quickest onset of action, less than 30 minutes, is oral and sublingual. Vaginal misoprostol has more bioavailability at 6 hours than oral or sublingual. Rectal misoprostol has a longer half-life than oral [6]. A review article examining studies that compared misoprostol administration with placebo demonstrated a significant difference in blood loss, with a mean estimated blood loss (EBL) of 347.5 mL when using misoprostol versus 539.3 mL when using placebo [6]. A small randomized controlled trial illustrated similar results. Women who received 400 mcg of misoprostol 1 hour before surgery had a mean EBL of 574 mL versus the placebo group's 874 mL [7].
Reducing Intraoperative Blood Loss in Myomectomy
Rooma Sinha, Arnold P. Advincula, Kurian Joseph in FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Misoprostol is a prostaglandin E1 analogue that reduces uterine blood flow, increases myometrial contractions, and has the potential to reduce blood loss during uterine surgery [9]. The evidence for misoprostol as an adjunct for myomectomy is limited and conflicting. However, even a single dose of misoprostol is efficacious in patients undergoing abdominal myomectomy. Placebo-controlled randomized studies have shown that a single dose of misoprostol 400 μg given vaginally 1 h prior or rectally 30 min prior to abdominal myomectomy resulted in a statistically significant reduction in operative time [10], blood loss, postoperative hemoglobin drop, and need for postoperative blood transfusion. No differences were observed in length of hospital stay [10]. In one randomized trial, no benefit was observed in the use of misoprostol alone for abdominal myomectomy, but misoprostol 400 μg by rectum combined with intravenous oxytocin (10 U/h) in women undergoing laparoscopically assisted vaginal hysterectomy found significant improvements in operative outcomes compared with placebo [11].
Hysteroscopic Myomectomy
Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay in Fibroids and Reproduction, 2020
Multiple interventions have been studied to facilitate cervical ripening with generally conflicting results. The goal of cervical ripening is to avoid complications, such as creations of a false passage, cervical tears, and uterine perforation; as well as to facilitate greater ease of procedure, likely to be considered more in operative versus diagnostic hysteroscopy. The use of misoprostol (vaginal, oral, or sublingual) in some studies has shown to be more effective in decreasing the need for cervical dilation than placebo in premenopausal but not in postmenopausal women. In addition, some studies showed misoprostol to decrease complications (as cervical laceration and false tracks), while others did not. Finally, misoprostol has side effects such as cramps, bleeding, nausea, and diarrhea [17–19]. One must, of course, take into account the parity of the patient, as cervical ripening for a diagnostic hysteroscopy in a multiparous woman is likely to be superfluous.
Misoprostol in the era of COVID-19: a love letter to the original medical abortion pill
Published in Sexual and Reproductive Health Matters, 2020
Ruvani T. Jayaweera, Heidi Moseson, Caitlin Gerdts
Faced with the ongoing crisis of COVID-19, fully utilising all WHO-recommended abortion methods is essential to expanding and maintaining access to abortion. The WHO recommends two regimens for safe and effective abortion care throughout pregnancy: misoprostol on its own, and mifepristone in combination with misoprostol.4 These medications, when used correctly, successfully terminate 80–95% of pregnancies without the need for surgical intervention, depending on regimen and pregnancy duration.11,12 Misoprostol, an essential component of both regimens, was originally developed as a treatment for gastric and duodenal ulcers; in the late 1980s, women in Brazil, unable to obtain abortions in the formal healthcare system, discovered its use as a safe and effective abortifacient.13 Clinical trials soon followed, and misoprostol was incorporated into clinic-based standards for abortion care around the world.
Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study
Published in Journal of Investigative Surgery, 2020
Francesca Falcone, Gennaro Raimondo, Michael Stark, Salvatore Dessole, Marco Torella, Ivano Raimondo
In the setting of cervical priming before operative hysteroscopy, misoprostol and natural osmotic dilators (laminaria) have been the best studied agents so far. Data from the literature indicate that both misoprostol and osmotic dilators before resectoscopic procedures add significant benefits in terms of baseline cervical dilatation and ease of additional dilatation, reducing the risk of complications [2–5]. The ideal misoprostol dose and route of administration, however, are not yet standardized. Furthermore, the possible benefits of misoprostol need to be weighed against its common side effects (abdominal pain, nausea, diarrhea, vaginal bleeding, increased body temperature). Overall, laminaria seems to be more effective than misoprostol in achieving a satisfactory cervical priming before operative hysteroscopy with fewer adverse effects [2]. Laminaria, however, has the disadvantage of requiring insertion and retention for one to two days.
Women’s experiences using drugs to induce abortion acquired in the informal sector in Colombia: qualitative interviews with users in Bogotá and the Coffee Axis
Published in Sexual and Reproductive Health Matters, 2021
Ann M. Moore, Juliette Ortiz, Nakeisha Blades, Hannah Whitehead, Cristina Villarreal
The majority of women in our sample or their intermediaries were provided with instructions by the seller on how to take the medication. Respondents reported a range of regimens were recommended by the sellers. Twenty-seven respondents were advised to just take one dose of misoprostol containing between three and eight pills, while the remaining women were instructed to take up to five doses of pills across various time periods ranging from a few hours to a few days. Almost all women receiving misoprostol from online sellers reported receiving instructions; these online sellers provided instructions via WhatsApp, on papers delivered with the pills, or via email. One woman shared with the study members the instruction sheet that the online seller sent her. It included information on misoprostol’s effectivity (95% effective until 63 days of gestation), how to administer the pills (two oral and two vaginal), what to expect after using misoprostol (bleeding, cramps, clots and seeing pregnancy tissue), what to do in case the pills didn’t work (take a second dosage of misoprostol 24 hours later and, if it also failed, a third dosage 48 hours after the second dosage), what pills to take to control pain (500 mg) and how to confirm the success of the abortion (take a pregnancy test or get a transvaginal ultrasound).
Related Knowledge Centers
- Mifepristone
- Prostaglandin
- Uterus
- Peptic Ulcer Disease
- Labor Induction
- Abortion
- Postpartum Bleeding
- Oral Administration
- NONsteroidal Anti-Inflammatory Drug
- Methotrexate