Published: 2019-06-29

Effect of oxytocin infusion versus tranexamic acid on reducing blood loss during hysteroscopic myomectomy: a randomized controlled trial

Sabry E. Mohamed, Amr M. El Helaly, Mohamed H. Salama


Background: Women undergoing hysteroscopic myomectomy are prone to significant blood loss and hematological disturbances. Oxytocin is a uterotonic drug, used mainly in obstetric practice. Tranexamic acid is a haemostatic drug that has been used to reduce blood loss after trauma and in many surgeries. The aim of our study was to compare the safety and efficacy of oxytocin versus tranexamic acid in reducing perioperative blood loss during hysteroscopic myomectomy.

Methods: This study included 60 patients scheduled for hysteroscopic myomectomy allocated into 2 groups: group A: received 10 mg/kg of tranexamic acid slowly intravenous after induction of anesthesia, while group B: received infusion of 10 IU of oxytocin at a rate of 400 mIU/min throughout the procedure. Preoperative and postoperative hemoglobin and hematocrit levels, need for blood transfusion, duration of operation, complications and medications adverse effects were recorded.

Results: The 2 groups were comparable in terms of the mean difference between preoperative and postoperative hemoglobin a hematocrit levels, operative time, operative complication and medications’ adverse effects. No patients needed blood component transfusion in either group.

Conclusions: It can be concluded that tranexamic acid and oxytocin are equally effective in reducing blood loss and transfusion requirements during hysteroscopic myomectomy with comparable good safety profiles. Both of them can be used according to availability and surgeon preferences.


Hysteroscopic myomectomy, Myomectomy, Oxytocin, Reducing blood loss, Tranexamic acid

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Falcone T, Parker WH. Surgical management of leiomyomas for fertility or uterine preservation. Obstetrics Gynecol. 2013;121(4):856-68.

Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obst Gynecol. 2003;188(1):100-7.

Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W. A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy. Fertility Sterility. 2013;100(4):1044-9.

Raga F, Sanz-Cortes M, Bonilla F, Casañ EM, Bonilla-Musoles F. Reducing blood loss at myomectomy with use of a gelatin-thrombin matrix hemostatic sealant. Fertility Sterility. 2009;92(1):356-60.

Saridogan E. Surgical treatment of fibroids in heavy menstrual bleeding. Women’s Health. 2016;12(1):53-62.

Mazzon I, Bettocchi S, Fascilla F, Palma F, Zizolfi B. Resectoscopic myomectomy. Minerva Ginecol. 2016;68(3):334-44.

Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Systematic Reviews. 2014. Available at doi/10.1002/14651858.CD005355.pub5/media/CDSR/CD005355/CD005355.pdf.

Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section-pilot study. ISRCTN 40302163. European Journal Obst Gynecol Repro Biol. 2009;142(1):30-3.

McCormack PL. Tranexamic acid. Drugs. 2012;72(5):585-617.

Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, et al. Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Arch Ortho Trauma Surg. 2000;120(9):518-20.

Wong L, Brun JL. Myomectomy: technique and current indications. Minerva Ginecol. 2014;66(1):35-47.

Mousa SA, Yassen AM, Alhadary HS, Sadek EE, Abdel-Hady ES. Hematological profile and transfusion requirement during hysteroscopic myomectomy: a comparative study between oxytocin and tranexamic acid infusion. Egyptian J Anaesth. 2012;28(2):125-32.

Sayyahmelli M, Moosazadeh R, Mostafa GP, Nazari F. Comparison of the intraoperative outcomes of intrauterine instillation of epsilon-aminocaproic acid and intravenous oxytocin in hysteroscopy surgeries. Int J Women’s Health Rep Sci. 2016;4(2):68-72.