Hemostatic Effect of Intrauterine Instillation of Oxytocin in Hysteroscopic Myomectomy: A Randomized Double Blinded Control Trial

Abstract

Introduction: Uterine myomas are benign, smooth muscle tumors of the uterus that are affected by estrogen and progesterone. Most fibroids are asymptomatic and require no intervention or further investigations. Fibroids arise from the uterine smooth muscles then migrate to a place of lower resistance becoming subserosal or submucous myomas or remains intra-myometrial. Aim of the Work: The main aim of this study was to investigate whether the intrauterine instillation of oxytocin into the distention medium during hysteroscopic myomectomy will reduce blood loss and improve surgical visibility. Patients and Methods: This Randomized controlled double blinded clinical trial was conducted at Early Cancer Detection Unit (ECDU) at Ain Shams University hospitals. This study included 60 women who were scheduled to undergo a hysteroscopic myomectomy were divided into two equal groups: Group A (Oxytocin group): 30 women underwent a hysteroscopic myomectomy with the use of 10 IU of oxytocin for every 1000 ml of the distending medium. Group B (Placebo group): 30 women underwent hysteroscopic myomectomy with the use of a sterile bacteriostatic water ampule for every 1000 ml of the distending medium. Results: Groups were comparable in demographic data (in terms of age) and surgical data sin term of (myoma size and number and duration of surgery) and intraoperative fluids and there was no statistically significant difference between groups. There were significant difference in Hgb and Hct drop in each group but control group showed more mean difference than oxytocin group. Our results showed that groups were comparable in post-operative need of blood transfusion and 2nd surgery and there was statistically significant difference between groups in post-operative Hgb and HCT. Groups were comparable in surgeon evaluation in term of visual fluid clarity and there was statistically significant difference between groups in surgeon rating bleeding. Our results showed that groups were comparable in complications in term of (uterine and medical) and there was no statistically significant difference between groups regarding complications. Conclusion: Complications during diagnostic hysteroscopy are common. Intrauterine instillation of oxytocin into the distention medium during hysteroscopic myomectomy reduce blood loss and improve surgical visibility. More studies with varied dosages and methods are needed to validate these findings.