Intravenous Tranexamic Acid Versus Pericervical Tourniquet To Decrease Blood Loss In Trans-Abdominal Myomectomy

Study Overview
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Brief Summary
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Intravenous Tranexamic Acid Versus Pericervical Tourniquet To Decrease Blood Loss In Trans-Abdominal Myomectomy

Detailed Description
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this study aims at comparing between different methods to decrease blood loss in trans-abdominal myomectomy. this study compares between medical (intravenous tranexamic acid administration) and non medical (pericervical tourniquet) methods in decreasing blood loss intra operative

Official Title
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Intravenous Tranexamic Acid Versus Pericervical Tourniquet To Decrease Blood Loss In Trans-Abdominal Myomectomy

Conditions
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Post Operative Hemorrhage

Intervention / Treatment
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* Drug: Tranexamic Acid
* Procedure: Pericervical Tourniquet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Women in the reproductive age (20 - 40 years) diagnosed as having uterine fibroids who are consenting to have trans-abdominal myomectomy in the postmenstrual period diagnosed by: Clinical symptoms and signs: Abnormal uterine bleeding (menorrhagia or (and) metrorrhagia). Pain (dull aching lower abdominal pain or dysmenorrhea). Pressure symptoms (dyspareunia, dysuria, dyschezia or (and) backache). Progressive abdominal enlargement (abdominal swelling). All women with clinical presentation suggestive of uterine fibroid will undergo abdominal and trans-vaginal ultrasound to confirm the clinical diagnosis and to exclude patients with: Submucous uterine myomas. Cervical or supracervical myomas. Broad ligamentary and pedunculated myomas. Associated pelvic pathology. Ultrasound criteria of uterine fibroids of included patients: Maximum diameter of the largest fibroid is greater than 4cm. Maximum number of uterine myomas is not to be more than 5 myomas. Uterine fibroid may be subserous or intramural. Exclusion Criteria: Obesity (body mass index >30 kg/m2). Cardiac, endocrine, pulmonary or hematological disease (including anemia; hemoglobin level below 10gm/dl). Patients known to be allergic to tranexamic acid. Patients who received pre-operative hormonal therapy (such as a GnRH analogue). Patients presented by or with suspected malignant gynecological disease. Patients diagnosed as having submucous uterine fibroids, cervical or supracervical fibroids, broad ligamentary fibroids and pedunculated fibroids. Patients with contraindication to general anaesthesia. Patients with positive pregnancy test. Virgin patients.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: tranexamic acid<br>bolus intravenous injection of tranexamic acid 10mg/kg (maximum1g) 15 min before incision followed by continuous infusion of 1mg/kg/h dissolved in 1L of saline for 10 h (maximum 1 g/10 h) | Drug: Tranexamic Acid<br> <br> * Other names: Kapron;|
| Active Comparator: Pericervical Tourniquet<br>The tourniquet method will be used where the urinary bladder will be dissected downwards from the lower uterine segment, and then a perforation will be made in the posterior leaflet of the broad ligament bilaterally at the level of uterine isthmus. A tourniquet (using 16- inch Foley catheter) will be passed through the perforation encircling the uterine arteries bilaterally. The Fallopian tubes and the ovaries will be carefully excluded from the line of the tourniquet to avoid direct compression and necrosis. The tourniquet will be released intermittently (at about 30 minutes interval) during the surgery and ﬁnally removed after the repair of the uterus | Procedure: Pericervical Tourniquet<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimated intra-operative blood loss measured in milliliters |  | first 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The need for intra-operative blood transfusion | It is indicated when intra-operative blood loss exceeds 15% of the patient's estimated blood volume, which is equal to the patient's weight in kilograms multiplied by 10 | 1 hour | 
| The need for conversion from myomectomy to hysterectomy | It is indicated when there is uncontrolled intra-operative hemorrhage affecting the patient's vital signs and not responsive to conservative measures or when it is impossible to reconstruct the uterus because of the many defects left by the removal of multiple fibroids | 1 hour | 
| Operative time in minutes |  | 1 hour | 
| Intra-operative or post-operative complications |  | 24 hours | 
| Difference between Pre and post-operative hemoglobin and hematocrit levels | Postoperative hemoglobin and hematocrit levels are to be measured 24 hours after the operation via a venous blood sample). | 24 hours | 
| Duration of hospital stay in days |  | 7 days |