الفهرس 
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Abstract
U
terine leiomyomas (also referred to as fibroids or myomas) are the most common pelvic tumor in women. They arise in reproductive-age women and, when symptomatic, typically present with symptoms of abnormal uterine bleeding and/or pelvic pain/pressure. Uterine fibroids may also have reproductive effects (e.g., infertility, adverse pregnancy outcomes).
Treatments include watchful waiting, medical/surgical interventions or interventional radiology (Uterine artery embolization, Magnetic resonance guided focused ultrasound or High-intensity focused ultrasound (HIFU)).
Surgeries such as myomectomy may involve significant blood loss. The average volume of blood loss during abdominal myomectomy is 200 to 800 ml. Surgical hemorrhage may result in anemia, hypovolemia, and coagulation abnormalities.
Various pharmacological and non-pharmacological methods have been tested to control haemorrhage during myomectomy including misoprostol, Intramyometrial vasopressin, Intramyometrial bupivacaine plus epinephrine, tranexamic acid, gelatin-thrombin matrix, ascorbic acid, dinoprostone, loop ligation, fibrin sealant patches, peri-cervical tourniquet, or tourniquet tied around both cervix and infundibulopelvic ligaments.
Vasopressin is a synthetic analogue of the posterior pituitary hormone antidiuretic hormone. It is often injected into the uterus to reduce blood loss during surgery. Vasopressin has vasoconstrictive effects at the V1 receptors within the uterus and stimulates uterine contraction by myometrial V1a receptors and because of its potent systemic vasoconstrictor, vasopressin may cause hypertension and bradycardia.
Vasopressin is not routinely used during conventional myomectomy due to non-availability and high cost.
Octreotide Acetate (OA) (Sandostatine), is an octapeptide that mimics natural somatostatin. OA has direct effects on vascular smooth muscle and in veins leading to vasoconstriction.
Our study is a randomized controlled trial carried out in Ain Shams University Maternity Hospitals. The included 47 women were distributed randomly into two groups:
1. Vasopressin group (A): the intended number was supposed to be 30 women, however due to severe life-threatening side effects the study group decided to terminate this study arm prematurely after including 17 women. Each woman received 20 IU vasopressin (1 ml) diluted in 20 ml saline.
2. Octreotide acetate group (B): 30 women were included in this arm. Each woman received 0.050 mg octreotide acetate (Sandostatine) (1 ml) diluted in 20 ml saline.
The aim of the study was to evaluate the efficacy of Intramyometrial injection of OA in comparison to Intramyometrial injection of vasopressin in reducing blood loss in abdominal myomectomy.
Pre- and post-operative hemoglobin and hematocrit and estimated blood loss (suction container + weight of used towels) are the indicators were used to detect the amount of blood loss during myomectomy.
Operative time, need for blood transfusion and operative complications were secondary items.
The results showed that the mean blood loss in OA group was 390.03cc with standard deviation 89.27 and 168.65cc with standard deviation 45.29 in vasopressin group with p-value 0.000 which indicates that there is highly significant difference in blood loss between two groups.
The mean reduction in hemoglobin was 1.78g/dl and 1.14 in OA group and Vasopressin group respectively with p value 0.000 which showed that there is highly significant difference between them. Only 3.3% of OA group (one patient) needed blood transfusion and no need for transfusion in the vasopressin group.
There is no statistically significant difference (p-value > 0.05) between studied groups as regard blood transfusion and hospital stay.
There is highly statistical significant difference (p-value < 0.01) between studied groups as regard operative time. The time consumed at vasopressin group was shorter than OA group and this indicates that vasopressin may be more effective than OA in decreasing amount of blood loss during abdominal myomectomy leading to decrease the time of operation.
Only one woman in OA group had CVS complication inform of transient bradycardia for one min and recurred by intra-venous atropine.
Two women in Vasopressin group had CVS complication, one woman had transient bradycardia and immediately managed by intra-venous atropine, the other woman developed sever hypertension 210/100, bradycardia 40/min, heaviness and numbness in right arm and admitted to ICU post-operative, ECG and MRI brain were done with no abnormalities and the patient discharged after 2 days with no neurological manifestations and normal vital signs.
After this unaccepted complication, the study group decided to terminate the vasopressin arm of the study prematurely after including 17 cases.
from our study we concluded that:
1. The use of local intra-myometrial OA is to be considered as an option for reducing blood loss during myomectomy.
2. OA is more available, low cost with and less side effects, but still efficacy is less than local vasopressin. This may be attributed to the low concentrations used in our study, and the less potency of OA as a vasoconstrictor agent.
3. Vasopressin is a potent vasoconstrictor agent and more effective in reducing blood loss during myomectomy but it is less available, high cost and has more side effects