EFFICACY OF TRANSCERVICAL VASOPRESSIN INJECTION VERSUSVAGINAL MISOPROSTOL DURING HYSTEROSCOPIC MYOMECTOMY IN REDUCING OPERATIVE BLOOD LOSS AND OPERATION TIME.

Abstract

Objective: To compare  the efficacy of transcervical vasopressin injection to submucous myoma versus vaginal misoprostol during hysteroscopic myomectomy in reducing intraoperative blood loss, clarity of field, amount of fluid used and time of procedure. 

Methods: This was a prospective, randomized, study on forty women with symptomatic submucous myoma presented mostly with bleeding and/or infertility scheduled for hysteroscopic myomectomy were randomized to groups (group A) 20 patients transcervical intramyoma vasopressin injection and (group B) 20patients with  vaginal misoprostol is used . Outcome measures of this study was operative time, fluid volumes, blood loss, and visual clarity were compared between the two groups. 

Results: 

There was statistically significant difference (p0.00**) between both groups regarding the time needed for myomectomy as it was (15.8 ± 4.8) minutes in the vasopressin group(group A) compared with (28.5 ± 5.5) minutes in the misoprostol( groupB). The intraoperative blood loss was with great significantly difference in both  groups, up to (85%) in the group Awere with “minimal” intra operative bleeding  but  for misoprostol  group only  (10%) who develop minimal bleeding (p0.00**) so that there were statistical significant difference between both groups regarding post-operative hemoglobin and hematocrit deficit which was less in vasopressin group. The degree of the visual clarity of the field was significantly higher in vasopressin group (mean in vasopressin group =7.5 compared with 5.2 in misoprostol group) as in VAS, 0 = worst visual clarity, 10= best visual clarity. Also, there was significantly less amount of distention media and fluid deficit in vasopressin group in comparison to misoprostol group,but with less time needed for cervical dilatation in misoprostol group49.4±15.6seconds while vasopressin group takes about 60.2±17.6seconds so there is high statitistical significant difference (p value 0.03). 

Conclusion: Direct intramyomal vasopressin infiltration during hysteroscopic myomectomy is more effective than vaginal misoprostol in reducing the operative time, blood loss, inflow volume, fluid deficit & getting better visual clarity, however it didn`t affect completeness of resection of myoma.