Effectiveness of intravenous ‎carbetocin ‎in reducing blood loss during abdominal ‎myomectomy, a clinical trial

ABSTRACT

Objective. Myomectomy is advised for symptomatic uterine leiomyomas in women who wish to preserve fertility and is associated with major blood loss. ‎The study aims to assess the effectiveness of intravenous ‎Carbetocin to control blood loss during ‎abdominal myomectomy‎ compared to pre-operative vaginal Misoprostol, intraoperative Oxytocin infusion, and using pericervical tourniquet.
Materials and Methods. This clinical trial included 120 women candidates for abdominal myomectomy and was randomized into four groups (30 in each). Group 1 received pre-operative vaginal Misoprostol. Group 2 started and continued an infusion of Oxytocin during myomectomy. Group 3 received Carbetocin just before the skin incision. Group 4 had a pericervical tourniquet during the myomectomy.
Results. In the Carbetocin group, the intraoperative blood loss was the least (285.50±33.12 ml) compared to the Misoprostol group (439.33±40.23 ml), the Tourniquet group (497.33±29.35 ml), and the Oxytocin group (607±44.81 ml). The hemoglobin and hematocrit reduction were the least in the Carbetocin group (0.71±0.17 gm/dl and 1.09±0.34%) compared to the Misoprostol group (1.16±0.43 gm/dl and 2.7±1.21%), the Tourniquet group (1.85±0.3 gm/dl and 2.87±0.92%), and the Oxytocin group (1.95±0.32 gm/dl and 3.39±1.76%). The operative time and the postoperative hospital stay were the least in the Carbetocin group (58±6.43 min / 1.23±0.43 days) compared to the Misoprostol group (75.73±4.62 min / 1.67±0.55 days), the Tourniquet group (80.87±3.43 min /1.97±0.41 days), and the Oxytocin group (88.1±4.62 min / 2.2±0.48 days).
Conclusions. Carbetocin during abdominal myomectomy is the most effective method as regards blood loss, operative time, postoperative hemoglobin and hematocrit, and postoperative hospital stays.