Intravenous Oxytocin Versus Tranexamic Acid in Reducing Blood Loss During Abdominal Myomectomy.
Condition: Myomectomy
MeSH terms: Hemorrhage
Study type: Interventional
Phase: Phase 4

Summary: 
      Uterine leiomyomas (fibroids) are the most common benign tumors among women. Fibroids are
      found in approximately 20% of women over 35 years of age. In 20-50% of patients, fibroids may
      cause problems such as heavy menstrual bleeding, anemia, pelvic pain, pressure symptoms from
      extrinsic compression of the colorectal and urinary tract. Surgery is indicated for
      symptomatic uterine leiomyomas; hysterectomy for women who have completed childbearing (women
      > 40 years old), and myomectomy for women <40 years old who wish to preserve uterus and
      fertility.
    

Detailed description: 
      Interventions:

      Preoperative

        -  Full history, where demographic characteristics will be reported and examination to
           detect the size and mobility of uterus.

        -  Informed consent will be taken from patients.

        -  Trans-vaginal U/S to assess number, size, and types of myomas.

        -  Preoperative full labs (Hemoglobin, hematocrit, INR, liver enzymes and kidney functions)

      Intra Operative

        -  Preoperative antibiotics will be given before the beginning of the operation. The
           operations will be performed as standard through a midline or Pfannenstiel incision by
           the same consultant gynecologist to ensure consistency of study procedures. All patients
           will receive general anesthesia. After the skin incision, the subcutaneous fat and
           abdominal fascia will be opened crosswise, and the rectus muscle will be opened on the
           midline. The parietal peritoneum will be opened longitudinally to reach the pelvic
           cavity. Subsequently, a self-retaining retractor will be inserted, and intestine will be
           packed. The uterus will be inspected for the number, location, and shape of myomas.
           Other pelvic organs will be inspected for any associated pathology. When possible,
           uterine incisions will be performed on the anterior wall or fundus in order to reduce
           postoperative adhesions. The incision will be performed using monopolar diathermy.
           Intracapsular enucleation of myomas will be performed by gently dissecting between the
           myoma and the pseudo-capsule. The myoma will be gently enucleated out. Meticulous
           hemostasis will be secured by low-voltage coagulation of feeding vessels. Myoma bed will
           be closed by 1 or 2 layers of interrupted vicryl sutures (Vicryl 1-0 polyglactin 910;
           Egycryl, Taisier CO, Egypt). No mechanical tourniquet or local vasoocclusive drugs
           (e.g., vasopressin) will be used intraoperatively.

        -  The study will include patients scheduled for open abdominal myomectomy and will be
           divided into three equal groups.

        -  All the three groups will take a standard dose of 400 microgram of misoprostol rectally
           one hour before the operation.

      Postoperative

        -  Estimation of Hemoglobin 6 hrs postoperatively and next day morning.

        -  Monitor Vital Signs and need for blood transfusion.

        -  Send myomas for pathology.
    

Intervention name(s): Tranexamic Acid; oxytocin; placebo
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Patients in the TXA group will be given 15 mg/kg of tranexamic acid (Cyklokapron@; Amoun Pharmaceutical Co., SAE) slowly intravenously 30 min before surgery followed by 10 mg/ kg/h infusion in 500 ml Ringer's by infusion pump till the end of the procedure.; An equal volume of normal saline syringe in a double blinded manner will be intravenously administered to the OXYtocin group 30 min before surgery and will be followed by one ampoule of oxytocin (10 U/mL/amp) (Syntocinon; Aventis Pharmaceutical Co.) will be added to 500 mL Ringer's solution running at a rate of 400 mU/min by infusion pump till the end of the procedure.; An equal volume of normal saline syringe in a double blinded manner will be intravenously administered to the Oxytocin group 30 min before surgery and will be followed by 500 ml saline infusion during the operation
Intervention MeSH terms: Tranexamic Acid; Oxytocin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention