Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for “large” uterine fibroids: comparison of clinical efficacy

Purpose

Laparoscopic myomectomy is the uterus-preserving surgical approach of choice in case of symptomatic fibroids. However, it can be a difficult procedure even for an experienced surgeon and can result in excessive blood loss, prolonged operating time and postoperative complications. A combined approach with laparoscopic uterine artery occlusion and simultaneous myomectomy was proposed to reduce these complications. The aim of this study was to evaluate the safety and efficacy of the combined laparoscopic approach in women with symptomatic “large” intramural uterine fibroids, compared to the traditional laparoscopic myomectomy alone.

Methods

Prospective nonrandomized case–controlled study of women who underwent a conservative surgery for symptomatic “large” (≥ 5 cm in the largest diameter) intramural uterine fibroids. The “study group” consisted of women who underwent the combined approach (laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy), while women who underwent the traditional laparoscopic myomectomy constituted the “control group”. A comparison between the two groups was performed, and several intraoperative and postoperative outcomes were evaluated.

Results

No significant difference in the overall duration of surgery between women of the “study group” and “control group” emerged; however, a significantly shorter surgical time for myomectomy was observed in the “study group”. The intraoperative blood loss and the postoperative haemoglobin drop were significantly lower in the “study group”. No difference in the postoperative pain between groups emerged, and the postoperative hospital stay was similar in the two groups.

Conclusions

The laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy is a safe and effective procedure, even in women with symptomatic “large” intramural uterine fibroids, with the benefit of a significant reduction in the intraoperative blood loss when compared to the traditional laparoscopic myomectomy.

     

Laparoscopic Myomectomy with Temporary Bilateral Uterine Artery Occlusion Compared with Traditional Surgery for Uterine Myomas: Blood Loss and Recurrence

Study Objective

To compare the surgical technique of temporary bilateral uterine artery blockage with titanium clips in laparoscopic myomectomy with traditional surgery for uterine myomas to determine efficacy, ability to control bleeding, and recurrence.

Hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy

Purpose

To evaluate changes in hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy.

Methods

A total of 185 women with symptomatic uterine fibroids who underwent laparoscopic myomectomy were enrolled in this study. Eighty-six women (study collective) received an intramyometrial injection of epinephrine and were compared to ninety-nine women (control collective) who underwent laparoscopic myomectomy without an intramyometrial epinephrine injection. Demographic parameters, change of hemodynamic parameters during surgery as well as hemoglobin drop after surgery were analyzed.

Results

In the study collective maximum systolic blood pressure (p?<?0.001), maximum increase of the systolic blood pressure within 5 min (p?=?0.003), duration of hypertension (p?=?0.012), maximal (p?<?0.001) and mean heart rate (p?=?0.005), maximal increase of heart rate within 5 min (p?=?0.003) and difference of mean to maximal heart rate (p?<?0.001) were higher compared to the control collective. There was no difference in pre- and postoperative hemoglobin levels in both collectives and no intraoperative clinically relevant complication occurred due to intramyometrial epinephrine injection.

Conclusion

The intramyometrial application of epinephrine seems to be safe but leads to significant alterations of hemodynamic parameters without a significant change in postoperative hemoglobin levels.

     

Effectiveness of the contemporary treatment of preterm labor: a comparison with a historical cohort

Aim

To evaluate the outcome of a cesarean myomectomy (CM) versus a cesarean delivery (CD) alone in women with uterine myomas and the risk factors for adverse outcomes.

Methods

A retrospective cohort study of all women undergoing CDs with uterine leiomyomatas and singleton pregnancies was performed. Patients with known risk factors for hemorrhage were excluded. Measured adverse outcome parameters included estimated blood loss, drop in hemoglobin levels (pre/postoperatively), operation time, and the use of additional uterotonics. Outcome parameters of women with CM were compared to women with CD alone. Possible risk factors for adverse outcomes were analyzed in a multivariate regression analysis. Evaluated risk factors for CM were according to localization and type of myomatas, the myoma size, BMI ≥30 kg/m², age ≥40 years, fetal weight ≥4 kg, repeat CD, and unplanned CD in the first stage of labor. The influence of localization and myoma type were further analyzed in a subgroup analysis.

Results

Of the 162 women with uterine myomatas during CD, 48 underwent CM and were analyzed. Overall, CM was not associated with adverse outcomes. Independent of a concomitant myomectomy, a large myoma size of ≥5 cm was associated with an increased blood loss of ≥500 ml (adj. OR 2.7 CI 95 % 1.2–6.2, p = 0.02), and women ≥40 years of age had a significant postoperative drop in hemoglobin (adj. OR 2.4 CI 95 % 1.0–5.4, p = 0.04). In the univariate subgroup analysis, CM of multiple myomatas was associated with an increased blood loss and an increased operation time compared to women with multiple myomatas and CD alone. Prolonged operation times were also observed in women with pedunculated and subserosal myomatas with concomitant myomectomy. There were no cases of hysterectomy or blood transfusions.

Conclusion

CM performed by an experienced obstetrician can be safe in selected patients who are without additional preexisting risk factors. Risk factors that are associated with increased blood loss in women with uterine leiomyomatas include a larger size of the leiomyoma (≥5 cm) and a maternal age of ≥40 years.

     

Three cases of laparoscopic myomectomy performed during pregnancy for pedunculated uterine myomas

Purpose

Laparoscopic myomectomy during pregnancy is indicated when symptoms related to uterine myomas persist despite pharmacologic therapy; however, currently there is very little information concerning its safety.

Methods

We report three cases of antepartum laparoscopic myomectomy performed to manage complicated myomas requiring surgical intervention.

Results

In particular, we report for the first time in literature the laparoscopic removal of two myomas in a patient during a single surgery performed in the 19th week of pregnancy followed by additional multiple myomectomy at the time of the cesarean section. All surgeries were without complication.

Conclusions

Our experience suggests that laparoscopic myomectomy may be performed safely during pregnancy; even more studies are needed to establish the exact rate of adverse events.     

MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids

Purpose

To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality.

Methods

The study group comprised 27 women [mean age 37.4?±?6.9?years (range 27–53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded.

Results

The mean time to MRI and clinical follow-up was 10?months (range 6–15?months). The mean uterine volume premyomectomy was 795?±?580?cc and postmyomectomy was 123?±?70?cc (p?<?0.001). The mean percentage reduction in uterine volume was 80.3?% (range 43.0–98.1?%). Of the 10/27 (37.0?%) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1?cc in volume, 3 patients had fibroids measuring up to 6?cc. Postoperative adnexal seromas were observed in 6/27 (22.2?%) patients. The clinical success rates of myomectomy amongst the 22/27 (81?%) responders were: 73?% for menorrhagia, 64?% for pain, and 36–64?% for mass-related symptoms.

Conclusions

Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.     

Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases

Bleeding is the most common complication in laparoscopic myomectomy. In this paper, we describe a new technique using Yasargil aneurysm clips to reduce blood loss during laparoscopic myomectomy by clipping the uterine arteries temporarily. Over a 7-month period, 13 patients with uterine fibroids larger than 5 cm underwent laparoscopic myomectomy with temporary clipping of both uterine arteries at their origin from the internal iliac artery. We assessed the clinical data of perioperative blood loss, operating time, hospital stay, complications, haemoglobin decrease and uterine artery Doppler flow prior to and after the procedure. No serious perioperative complications occurred. The mean number of removed fibroids was 7.5 (range 1–30), with an average total weight of 421 g (range 160–960 g). Mean Hb pre- vs. postoperatively was 12.5 g/cl vs. 10 g/cl. There was no significant change in the uterine artery flow prior to and after surgery. No transfusion was given to any of the patients. We conclude that temporary clipping of the uterine arteries prior to laparoscopic myomectomy is a safe procedure for controlling excessive blood loss without jeopardising the uterine blood supply.     

Comparison of robotic-assisted laparoscopic myomectomy outcomes with laparoscopic myomectomy

Purpose

This study aimed at comparing short-term outcomes of patients who underwent robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy.

Methods

From January 2008 to August 2010, prospective data including 15 consecutive patients who underwent robotic-assisted myomectomy (RALM) with the da Vinci surgical system were recorded. These cases were compared with a retrospective cohort of 23 patients who underwent laparoscopic myomectomy (LM). Patient demographics, fibroid characteristics and peri-operative data (operative time, anesthesia time, set-up time, console time for robotic cohort, Estimated blood loss (EBL), length of hospital stay, conversion to laparotomy and operative complications were collected in both groups.

Results

Mean operative time for the robotic group was 138.73 ± 39.51 min compared with 140.57 ± 38.17 min for the laparoscopy group (p = 0.887). No significant differences were noted between RALM versus LM for hospital stay (1.67 ± 0.58 vs. 1.87 ± 0.67 days, p = 0.369) and EBL (101.33 ± 39.84 vs. 119.78 ± 43.70 ml, p = 0.549). The numbers, size and location of myomas removed for two groups were similar. None of the cases in both groups required conversion to laparotomy. There were no significant intra-operative and post-operative complications in either group.

Conclusion

RALM appears to provide the same surgical outcomes when compared with traditional laparoscopic myomectomy.     

Estudio comparativo de la miomectomía laparotómica frente a laparoscópica

Objective

To compare the outcomes of laparotomic versus laparoscopic myomectomy in the gynecology service of a Spanish hospital.

Material and methods

We performed a retrospective, comparative study of myomectomies performed between January 2005 and December 2007. The variables analyzed were demographic data, preoperative use of GnRH analogues, mean operating time, reconversion rate, postoperative pain, variations in the hemoglobin count, mean length of hospital stay, maximum myoma weight, the overall complications rate, and postoperative fertility.

Results

During the study period, 35 myomectomies (19 laparotomic and 16 laparoscopic) were performed. The mean operating time was 88 minutes in the laparotomic group and 104 minutes in the laparoscopic group (P<.05). In the laparotomic group, hemoglobin loss was 2.87 g/dl, rescue analgesia was required in 52.6% of the women and the mean length of hospital stay was 3.1 days. In the laparoscopic group these values were 3.26 g/dl, 6.22% and 1.7 days, respectively.

Conclusions

In well-trained and experienced hands, laparoscopic myomectomy is an effective alternative to the laparotomic route in well-selected patients.     

Two novel classification systems for uterine fibroids and subsequent uterine reconstruction after myomectomy

Objective

Laparoscopic approaches are the gold standard surgical treatment for intramural and subserous fibroids, whereas submucosal myomas can be treated via hysteroscopy. Removal of intramural myomas often requires a subsequent reconstruction of the uterine wall that ranges from single- to multiple-layer sutures to complex reconstructions. Several classification systems are currently used to characterize uterine fibroids, all of which focus on the assessment of submucosal fibroids during hysteroscopic myomectomy. There are no classification systems for the comprehensive localization of fibroids or for uterine reconstruction after myomectomy. Therefore, the aim of this study was to validate a new scoring system developed by our group to classify uterine leiomyoma as well as a standardized assessment scoring system for uterine reconstruction after surgical myomectomy.

Methods/Patients

To validate the uterine fibroid and uterine reconstruction classification systems, a retrospective review of 136 patients undergoing surgical myomectomy and uterine reconstruction at a single tertiary institution was performed. The age of the patient, duration of surgery, number, size, and location of excised fibroids, number of uterine incisions, level of uterine reconstruction, desire for future pregnancies, pre- and postoperative hemoglobin concentrations, duration of postoperative hospitalization, and operating surgeon were obtained by medical chart review. For each patient, a specific fibroid score and the level of uterine reconstruction were determined according to the classification systems. Correlations between the uterine fibroid and reconstruction scores, as well as between the classification scores and perioperative parameters, were analyzed.

Results

The newly developed classification system for uterine fibroids incorporates the number, location, and size of myomas, as well as the number of uterine incisions required for myomectomy. The uterine reconstruction scoring system comprises four levels of reconstruction, ranging from no reconstruction to advanced reconstruction. Outcomes from 136 patients showed a correlation between uterine fibroid and uterine reconstructive scores. High fibroid scores were correlated with higher levels of reconstruction. Both scoring systems showed associations with the duration of surgery, intraoperative blood loss, and days of hospitalization.

Conclusions

This study presents the first scoring system for uterine fibroids that incorporates all possible fibroid locations and a standardized assessment of uterine reconstruction. Scoring systems were validated in a large cohort, and a correlation was identified between uterine fibroid and uterine reconstruction scores. In daily clinical practice, this scoring system allows a better planning of surgery, specifically of the estimated duration of surgery, blood loss, and time of hospitalization.

     

Vaginal sacrocolporectopexy for the surgical treatment of uterine and vaginal vault prolapses: confirmation of the surgical method and perioperative results of 101 cases

Purpose

In this study, we sought to confirm the surgical method of vaginal sacrocolporectopexy and previously reported positive perioperative results of this procedure in a large patient group. We describe the approach which offers a vaginal, safe alternative to sacrospinous repair, laparoscopic or open vaginosacropexy and the use of synthetic meshes to treat pelvic organ prolapse.

Methods

We conducted a monocentric, prospective, nonrandomized study for treatment of patients with uterine and vaginal vault relapse (grade 2–4). All patients underwent a preoperative urogynecological urodynamic examination. We focus on method, operative time, complications, blood transfusions, hospital stay and clinical data.

Results

Between March 2006 and March 2011, 101 consecutive patients of mean age 64 (40–89) years, with sub or total uterine prolapse (n?=?69, grade 2–4) and vaginal vault prolapse (n?=?32, grade 2–4) were treated with vaginal sacrocolporectopexy. Cystocele (grade 2–4) was found in 88 (87.1?%) and rectocele (grade 2–4) in 43 (42.5?%) patients. Mean duration of surgery with sacrocolporectopexy was 70?min (28–165) without hysterectomy, and 76?min (40–219) with hysterectomy. Regression analysis of all patients (n?=?101) showed a significant decrease of operative time in the group without hysterectomy after 40 cases. Three bladder lesions, two in patients with a history of hysterectomy, occurred during surgery and were corrected intraoperatively without further complications. No patient required a blood transfusion. Hemoglobin levels decreased slightly from a preoperative mean of 13.6?mg/dl (10.3–15.7) to a postoperative mean of 11.7?mg/dl (8.6–14.7).

Conclusion

Vaginal sacrocolporectopexy is a safe vaginal method for the treatment of sub-/total uterine/vaginal vault prolapse.     

Evaluation of SprayShield™ Adhesion Barrier in a single center: randomized controlled study in 15 women undergoing reconstructive surgery after laparoscopic myomectomy

Objective

The objective of this study was to evaluate the safety and efficacy of SprayShield? Adhesion Barrier in preventing and/or reducing postoperative adhesion during gynecological surgery.

Design

This was a prospective, controlled, blinded, and randomized study. Patient blinding was performed intraoperatively. Subjects were randomly assigned to the SprayShield? or the control group in a 2:1 ratio.

Setting

The study was conducted at the Clinic of Gynaecology and Obstetrics, at the University Hospital for Gynecology in Germany.

Patients

Fifteen patients participated in this study; nine patients were assigned to the SprayShield? and six patients to the control group.

Interventions

During first operation (FLL) in the SprayShield? group, the agent was applied to all myomectomy suture lines. Patients in the control group did not receive any anti-adhesion treatment, only good surgical practice. A second-look laparoscopy (SLL) was performed 8–12 weeks after myomectomy to evaluate adhesion formation.

Main outcome measures

Main outcome measures were incidence, severity, and extent of uterine adhesions.

Results

No significant differences were found between the two study groups.

Conclusions

SprayShield? is easy to use. No serious adverse event related to SprayShield? was observed. Efficacy data are inconclusive regarding the performance of SprayShield?. Further studies are needed to better understand this performance.     

Comparison of uterine exteriorization and in situ repair during cesarean sections

Purpose

To compare the peri- and postoperative complication rates of two cesarean delivery techniques.

Methods

Medical records from 1,087 patients who had a cesarean delivery with regional anesthesia between 2008 and 2010 were reviewed retrospectively. Seven hundred and thirty-two patients had an in situ uterine repair, and 355 patients had an exterior uterine repair. Patients who had chorioamnionitis, preeclampsia, a bleeding disorder, or abnormal placentation were excluded from the study. The following outcomes were compared between the two groups: mean operative time, intraoperative blood loss, perioperative nausea, tachycardia, hypotension, hemoglobin level, hematocrit level, the time to the first recognized bowel movement, postoperative analgesic dose, nausea, length of hospital stay, surgical site infection rate and endometritis rate.

Results

No clinically significant differences were found between the exteriorization and in situ uterine repair groups for mean hematocrit differences, intraoperative blood loss, perioperative nausea, tachycardia, hypotension and postoperative analgesic doses. However, the mean operative time, time to the first recognized bowel movement, surgical site infection rate and length of hospital stay were significantly lower in the in situ repair group (p?Conclusion Although the techniques are similar in most scenarios, in situ uterine repair during cesarean sections appears to be more advantageous than exteriorization with respect to the mean operative time, time to the first recognized bowel movement, surgical site infection rate and length of hospital stay.     

Abdominal colposuspension with the use of tension-free tape at the lateral abdominal wall: a novel technique

Introduction

The aim of this study was to present a novel technique for the female pelvic organ prolapsed, an abdominal colpopexy at the lateral abdominal wall (ACLAW) using a tension-free tape and to compare it with the gold standard, the abdominal sacrocolpopexy (ASC).

Materials and methods

A retrospective comparative study was conducted consisting of 38 patients who underwent ACLAW and 40 patients who underwent ASC during the period 2007–2009. POP-Q data as well as PISQ-12 and POPDI-6 score values were recorded during a mean follow-up of 26.71 and 23.52?months for ACLAW and ASC groups, respectively. Parameters like operative time, blood loss and hospital stay time were evaluated as well.

Results

Except the 6-month point, anatomical outcome in terms of C point values and total vaginal length was comparable. Both score analyses did not demonstrate statistically significant differences between the groups. The novel technique was proved very much shorter (30?±?10.2 vs. 125.93?±?15.42?min, p?Conclusions Based on the study results, ACLAW, a technique much easier and shorter than the traditional abdominal colpopexy results in comparable outcomes.     

Reducing blood loss during open myomectomy with intravenous versus topical tranexamic acid: A double-blinded randomized placebo-controlled trial

Objectives

To assess the effect of Intravenous versus Topical Tranexamic acid in reducing intra-operative and post-operative blood loss in abdominal myomectomy surgeries.

Pisat’s Visual Vasopressor Injection Needle: A New Device for Increasing Patient Safety in Laparoscopic Myomectomy

Introduction

The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intra-myometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution.

Aims and Objectives

To describe a new design of an injection needle, Pisat’s Visual Vasopressor Injection Needle (VVIN), that can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution.

Results

A total of 53 patients who underwent laparoscopic myomectomy at various hospitals in Mumbai, India, were studied over a period of two years. Out of these, 23 patients were operated upon using a standard 5-mm laparoscopic injection needle, and 30 patients were operated upon by using a VVIN. Out of the 23 patients in whom a regular needle was used, four patients (17.39%) demonstrated a significant (over 20 percent of pre-injection value) but transient elevation in pulse and blood pressure readings at 1-min post-injection. This gradually returned to baseline at 10 min after the injection. None of the 30 patients in whom VVIN was used after confirming a negative aspiration demonstrated any significant change in post-injection pulse or blood pressure recordings.

Conclusions

Using a VVIN during a laparoscopic myomectomy enables the surgeon to detect an inadvertent vascular puncture very early, even in a small calibre blood vessel, and with much more sensitivity than a regular needle. This increases patient safety during the intra-myometrial injection of a vasoconstrictive agent during myomectomy and reduces the incidence of catastrophic complications.

     

Single-port laparoscopic myomectomy: initial operative experience and comparative outcome

Objective

To present the initial operative outcome and comparative data among patients undergoing single-port laparoscopic myomectomy (SPLM).

Materials and methods

A prospective, observational study of all patients who underwent SPLM was performed. The demographic and operative data, including age, body mass index, operative indications, operative time, estimated blood loss, complications, and postoperative hospital stay were recorded. A match cohort of patients undergoing traditional LM was also retrospectively compared.

Results

SPLM was successfully performed in all ten patients from April 2010 to October 2010. The two groups (SPLM and traditional LM) were matched by age, body mass index, size, and weight of fibroids. The median operating time (196.5 vs. 82.5 min, P < 0.001) and length of hospitalization (3 vs. 2 days, P = 0.042) were significantly longer in SPLM group than in traditional LM group. The median operative blood loss was not significantly different. No patients in either group had serious complications.

Conclusion

Despite the increased operating time, SPLM is feasible and offers comparable surgical outcomes and superior cosmesis compared with traditional LM.     

A pilot study of Foley’s catheter balloon for prevention of intrauterine adhesions following breach of uterine cavity in complex myoma surgery

Purpose

During abdominal myomectomy for removal of multiple fibroids, the uterine cavity may be breached. Repair of the breach is associated with a risk of development of intrauterine adhesions. We conducted a pilot study to evaluate the effectiveness of temporary placement of a Foley’s catheter balloon inflated with 30 ml normal saline into uterine cavity at the end of surgery to prevent this complication.

Methods

Retrospective cohort study. When the uterine cavity was breached during open myomectomy, it was repaired with a No. 2-0 vicryl suture. A Foley catheter balloon was inserted into the uterine cavity at the end of the procedure, and the balloon distended with 30 ml of normal saline. The balloon was removed on the fourth post-operative day. Follow-up hysteroscopy was performed after 6 months.

Results

At the time of follow-up hysteroscopy 6 months after the myomectomy, we found no intrauterine adhesions in 16 consecutive women treated with balloon, compared to 3 out of 10 (30 %) historical controls where the balloon was not used.

Conclusion

A Foley catheter balloon inserted into the uterine cavity following breach and repair of the uterine cavity at open myomectomy appears to prevent the formation of intrauterine adhesions.     

Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study

Study Objective

To compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects.

Role of Misoprostol 600 mcg Oral in Active Management of Third Stage of Labor: A Comparative Study with Oxytocin 10 IU i.m

Objectives

To compare oral misopostol 600 mcg with 10 IU units oxytocin i.m. in the active management of the third stage of labor.

Materials and Methods

A total of 200 pregnant women of 34–42 weeks of gestation delivering vaginally in the Rajendra Institute of Medical Sciences, Ranchi, were selected for study. Hundred women received oral misoprostol 600 mg and 100 women received i.m. oxytocin 10 IU immediately after delivery of the baby and cord clamping by the method of randomization.

Results

In the misoprostol group, mean blood loss is 145 ml, mean duration of the third stage of labor is 3.76 min, and mean fall in hemoglobin is 0.55 g/dl. In the oxytocin group, mean blood loss in 125.6 ml, mean duration of the third stage of labor in 3.50 min, and mean fall in hemoglobin is 0.48 g/dl. There was no significant difference between the two groups with regard to the above-mentioned factors. There were 8 cases of PPH in the misoprostol group and 6 cases in the oxytocin group. Twenty-two cases in the misoprostol group and 16 cases in the oxytocin group required additional oxytocics. Adverse effects like shivering and pyrexia were more in the misoprostol group.

Conclusion

Oral misoprostol is as effective as oxytocin in AMTSL and can be used safely in vaginal deliveries for prevention of PPH, especially in non-institutional deliveries and in places of low resource settings.