Comparative study of intravenous tranexamic acid and intravenous oxytocin in the control of bleeding during hysterescopic myomectomy in women with abnormal uterin bleeding

Abstract

Abnormal uterine bleeding is one of the most common causes of women who referring to gynecology clinics .One of the treatments approaches is removal of myoma by hysteroscopy. For reduction of bleeding volume during hysteroscopic myomectomy, several measures were performed. Therefore, the aim of this study was to compare the effects of tranexamic acid and oxytocin on bleeding during hysteroscopic myomectomy in women with abnormal uterine bleeding. Materials and Methods: This observer blinded clinical trial was conducted on patients undergoing operative hysteroscopy in Alzahra teaching hospital. By consideration of inclusion and exclusion criteria, 92 patients were classified into two groups. After general anesthesia, and upon insertion of the hysteroscope into the uterus, 46 patients in first group received 10 mg / kg of tranexamic acid in 500 ml of Ringer's serum at 10 ml per minute intravenous infusion, and for 46 patients in second group, 5 units of oxytocin were administered in 500 ml of ringer serum by 10 ml / min intravenous infusion. In both groups, dextrose solution 5% was used as a media for dilatation of the uterine cavity. The amount of bleeding, absorbed volume, the success rate of surgery, resolution of hysteroscopy image, side effects of two drugs, days of hospital stay, all were recorded in a pre-designed checklist and compared between 2 groups by SPSS 21. Results: In this clinical trial, 92 patients in both groups were matched for age, gravidity, parity and number of intrauterine myomas. Grade 0, 1 and 2 of intraoperative bleeding were observed in 76.1%, 23.9%and 0% Of patients in the Tranexamic acid 13% , 54.3% and 26.1% Of patients in Oxytocin group ,respectively (p=0.000, p=0.003 and p=0.000). Patients treated with Tranexamic acid had significantly shorter operation time (11.5±7.24 minutes vs 21.23±11.7 minutes) and significantly brightly hysteroscopic view (97.8% vs 65.2%) compared whit Oxytocin group. The hemoglobin and hematocrit changes, hospital stay duration, the mean volume absorbed media, sodium and potassium changes and medications side effects were similar in the two groups. Myomectomy was done successfully in the two groups.