Summary of findings for the main comparison. Interventions to reduce blood loss during myomectomy for fibroids compared to placebo or no treatment.
| Interventions to reduce blood loss during myomectomy for fibroids compared to placebo or no treatment | ||||||
| Population: Women with fibroids Settings: Various settings in low income, middle income, and high income countries Intervention: Diverse interventions Comparison: Placebo or no treatment | ||||||
| Intervention | Illustrative comparative risks (95% CI) on blood loss | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Placebo or no treatment | Interventions | |||||
| Misoprostol in abdominal myomectomy | Mean blood loss with placebo was 621 ml | Mean blood loss with misoprostol was 149.00 ml lower (229.24 to 68.76 lower) | MD ‐149.00 (‐229.24 to ‐68.76) | 25 (1 study) | ⊕⊕⊕⊝ moderate | We rated down the quality of evidence (by 1) because the data were derived from one small study |
| Misoprostol in laparoscopic myomectomy | Mean blood loss with placebo was 322.39 ml | Mean blood loss with misoprostol was 91.00 ml lower (120.44 to 61.56 lower) | MD ‐91.00 (‐120.44 to ‐61.56) | 64 (1 study) | ⊕⊕⊕⊝ moderate | We rated down the quality of evidence (by 1) because the data were derived from one small study |
| Vasopressin | Mean blood loss with placebo was 483.09 ml | Mean blood loss with vasopressin was 245.87 ml lower (434.58 to 57.16 lower) | MD ‐245.87 (‐434.58 to ‐57.16) | 128 (3 studies) | ⊕⊕⊕⊝ moderate | We rated down the quality of evidence (by 1) because the data were derived from three small studies |
| Bupivicaine plus epinephrine | Mean blood loss with placebo was 212.5 ml | Mean blood loss with bupivicaine‐epinephrine was 68.6 ml lower (93.69 to 43.51 lower) | MD ‐68.60 (‐93.69, ‐43.51) | 60 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, with a high risk of attrition bias (2 patients in each arm did not receive assigned intervention because of concomitant disease) |
| Intravenous injection of tranexamic acid | Mean blood loss with placebo was 1047 ml | Mean blood loss with tranexamic was 243 ml lower (460.02 to 25.98 lower) | MD ‐243.00 (‐460.02 to ‐25.980 | 100 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study and the pooled effect estimate was imprecise |
| Gelatin‐thrombin matrix | Mean blood loss with placebo was 625 ml | Mean blood loss with Gelatin‐thrombin was 545 ml lower (593.26 to 496.74 lower) | MD ‐545.00 (‐593.26 to ‐496.74) | 50 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, and it is unclear if outcome assessors were blind |
| Ascorbic acid | Mean blood loss with no treatment was 932.9 ml | Mean blood loss with ascorbic acid was 411.46 ml lower (502.58 to 320.34 lower) |
MD ‐411.46 (‐502.58 to ‐320.34) |
102 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, and it is unclear how allocation concealment was done |
| Dinoprostone (prostaglandin E2 analogue) | Mean blood loss with placebo was 485.7 ml | Mean blood loss with dinoprostone was 131.6 ml lower (253.42 to 9.78 lower) |
MD ‐131.60 (‐253.42 to ‐9.78) |
108 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, and the effect estimate has wide confidence intervals |
| Loop ligation of myoma pseudocapsule plus vasopressin | Mean blood loss with no treatment was 363.68 ml | Mean blood loss with loop ligation was 305.01 lower (354.83 to 255.19 lower) |
MD ‐305.01 (‐354.83 to ‐255.19) |
70 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, and it is unclear how allocation concealment was done |
| Fibrin sealant patch (collagen sponge with thrombin and fibrinogen) | Mean blood loss with no treatment was 151.1 ml | Mean blood loss with tachosil was 26.5 ml lower (44.47 to 8.53 lower) |
MD ‐26.50 (‐44.47 to ‐8.53) |
70 (1 study) | ⊕⊕⊝⊝ low | We rated down the quality of evidence (by 2) because the data were derived from one small study, and the effect estimate has wide confidence intervals |
| CI: Confidence interval; MD: mean difference | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||