Preoperative Misoprostol to Reduce Blood Loss and Related Morbidities During Abdominal Hysterectomy: a Systematic Review and Meta-analysis of 10 Randomized Placebo-Controlled Trials

• Published in: Reproductive sciences (Thousand Oaks, Calif.) Calif.), 2023-05, Vol.30 (5), p.1470-1481
• Main Authors: Abu-Zaid, Ahmed, Mohammed, Yasmine Adel, Baradwan, Saeed, Sayad, Reem, Faraag, Esraa, Mohammed, Eman Reda, Mohammed, Suhaila Mamdouh, Ashour, Ahmed Samy
• Format: Article
• Language: English
• Subjects: Embryology; Female; Humans; Hysterectomy - adverse effects; Medicine; Medicine & Public Health; Misoprostol - adverse effects; Obstetrics/Perinatology/Midwifery; Randomized Controlled Trials as Topic; Reproductive Medicine; Review
• ISSN: 1933-7191; 1933-7205
• DOI: 10.1007/s43032-022-01121-8

The objective of this study is to perform a meta-analysis of all randomized controlled trials (RCTs) that surveyed the efficacy and safety of preoperative misoprostol versus placebo during abdominal hysterectomy. Six databases were screened from inception until 3 August 2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model. Ten RCTs with 1076 patients (misoprostol = 537, placebo = 539 patients) were analyzed. Six and four RCTs had an overall low and high risk of bias (single-blinded), respectively. The mean intraoperative blood loss ( n  = 10 RCTs, MD  =  − 78.97 ml, 95% [− 130.89, − 27.06], p  = 0.003), mean difference in hemoglobin drop ( n  = 10 RCTs, MD  =  − 0.42 g/dl, 95% CI [− 0.69, − 0.14], p  = 0.003), and mean length of hospital stay ( n  = 5 RCTs, MD  =  − 0.2 d, 95% CI [− 0.24, − 0.16], p