Effect of Intramyometrial Carbetocin Injection during Myomectomy Operations

Abstract

Although uterine fibroids are benign and mostly common in about 20% of women over 35 years of age in recent years, its incidence has shown a rapid growth trend. Uterine fibroids can cause excessive menstrual flow, menstrual disorders, pelvic sense of urgencyand other symptoms. It can also be an important cause of subfertility. For uterine fibroids, there is no effective drug therapy, Surgical resection is still the main treatment,Surgical removal of myomas by abdominal myomectomy is one of the most common and successful methods of treatment. And since fibroid uterus has an increased number of arterioles and venules and myomectomy may involve significant blood loss. Myomectomy is perhaps one of the bloodiest gynecologic operations performed, and the most significant morbidity associated with it includes blood loss ,excessive bleeding during the operation requiring blood transfusions and even conversion into uterine hysterectomy.The average volume of blood loss during abdominal myomectomy is 200 to 800 mL and for laparoscopic myomectomy is 80 to 250 ml. A variety of methods have been described that are aimed at minimizing blood loss. For the majority of scholars, how to reduce the amount of intraoperative bleeding has become a major concern.Several techniques have been studied like the use of vasopressin and also providing tourniquets to control bleeding intra-operatively. In the current study we were concerned about studying the hemostatic effect of intramyometrial Carbetocin injection perhaps it might be used as an effective drug in abdominal myomectomies. 60 female patients with uterine fibroids of average size of 3-7 cm underwent abdominal myomectomy operation at Ain Shams Maternity Hospital at the period of 1st of July 2015 till 1st of January 2016. Patients were randomly categorized into two groups: the study group (30 patients) who received intramyometrial Carbetocin 100μg carbetocin and the control group (30 patients) who received placebo (saline). The age of patients in the study group ranged from 24 to 45 years old with a mean age of 32.6 ± 4.1 years old and the parity ranged from o to 4 while for the control group the age of patients ranged from 25 to 44 years old with mean age of 32.5 ± 4.7 years old and parity also ranged from 0 to 4. In the study group, 7 patients (23%) did previous lower abdominal surgery and 7patients (23.3%) did uterine surgery, while in the control group, 7patients (23.3%) did previous lower abdominal surgeries and 6 patients (20%) did previous lower uterine surgery.