Summary of findings 5. Peri‐cervical tourniquet compared to no treatment to reduce blood loss during myomectomy for fibroids.
| Peri‐cervical tourniquet compared to no treatment to reduce blood loss during myomectomy for fibroids | ||||||
| Patient or population: Women with fibroids Settings: Low and high income countries Intervention: Tourniquet around the cervix only, or around both the cervix and the infundibulopelvic ligament Comparison: No treatment | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| No treatment | Peri‐cervical tourniquet | |||||
| Blood loss (ml) Estimated blood loss during myomectomy | The mean blood loss in the control groups was 756.4 ml (for cervical tourniquet) &2359.0 ml (for cervical plus infundibulopelvic ligament tourniquet) | The mean blood loss in the intervention groups was 240.70 ml lower (359.61 ml lower to 121.79 ml lower) for the cervical tourniquet study & 1870 ml lower (2547.16 ml lower to 1192.84 ml lower) for the cervical plus infundibulopelvic ligament tourniquet study | MD ‐240.70 (‐359.61 to ‐121.79) for cervical touniquet study & ‐1870 (‐2547.16 to ‐1192.84) for the cervical plus infundibulopelvic ligament tourniquet study | 121 (2 studies) | ⊕⊕⊝⊝ low1 | We rated down the quality of evidence (by 2) because the data were derived from two small studies that were not pooled together due to significant clinical and statistical heterogeneity. One study used polyglactin suture round both the cervix and infundibulopelvic ligament, while the other used a Foley catheter round the cervix. |
| Need for blood transfusion Participants who received blood transfusion | 539 per 1000 for cervical tourniquet study &786 per 1000 for cervical plus infundibulopelvic ligament study | 204 per 1000 for cervical tourniquet study &71 per 1000 for cervical plus infundibulopelvic ligament study |
OR 0.22
(0.09 to 0.55) or cervical tourniquet study & OR 0.02 (0.00 to 0.23) for cervical plus infundibulopelvic ligament study |
121 (2 studies) | ⊕⊕⊝⊝ low1 | We rated down the quality of evidence (by 2) because the data were derived from two small studies which were not pooled together because of significant heterogeneity. One study used polyglactin suture round both the cervix and infundibulopelvic ligament, while the other used a Foley catheter round the cervix. |
| Duration of surgery (min) Operative time | The mean duration of surgery in the control groups was 118 min | The mean duration of surgery in the intervention groups was 4 min lower (29.28 lower to 21.28 higher) |
MD ‐4.00 (‐29.28 to 21.28) |
28 (1 study) | ⊕⊝⊝⊝ very low | We rated down the quality of evidence (by 3) because the data were derived from one small study and the effect estimate was imprecise |
| CI: Confidence interval; MD: mean difference; OR: Odds ratio | ||||||
| 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. | ||||||
1In one trial the allocation concealment was unclear and in the other trial allocation concealment was achieved by sealed sequentially‐numbered opaque envelopes containing computer‐generated random numbers.