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The Route of Misoprostol in Reducing Blood Loss for Transperitoneal Myomectomies: A Systematic Review and
Nadi Kaonga1, Emma Patterson1, Mariana C Sanchez-Medina1
1Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; Tufts University School of Medicine, MaineHealth Medical Center, Portland, Maine; Department of Obstetrics and Gynecology, Kaiser Oakland, Oakland, California; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado; Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia; and Center for Interdisciplinary Population & Health Research and Department of Obstetrics and Gynecology, MaineHealth, Portland, Maine.
Objective:
To compare the efficacy of different routes of misoprostol administration (sublingual, vaginal, rectal) in reducing intraoperative blood loss, which remains a concern for the surgical management of uterine leiomyomas.
Data Sources:
The protocol was registered in PROSPERO (CRD42025637576). Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, we searched several databases (Ovid Medline, Embase, Scopus, Web of Science, Cochrane, Global Health, Global Index Medicus, ClinicalTrials.gov) through June 2024.
Methods Of Study Selection:
The references were screened and data were abstracted in Covidence for studies meeting inclusion criteria. Title abstract screening was conducted, followed by full-text review and then data abstraction. Analyses were conducted with R.
Tabulation Integration And Results:
There were 328 studies identified in the initial search. Of those, 26 studies were included for analysis, but only 20 were able to undergo network meta-analysis against the primary outcome of interest (blood loss). Rectal misoprostol administration was associated with the largest mean reduction in intraoperative blood loss (mean difference -152.43 mL, 95% CI, -228.43 to -76.44, P<.0001), followed by vaginal administration (mean difference -69.46 mL, 95% CI, -122.11 to -16.82, P=.010). Sublingual administration was not statistically significant (mean difference -92.13 mL, 95% CI, -234.95 to 50.70, P=.206). Across other key outcomes (eg, blood transfusion, operative time), rectal misoprostol generally outperformed vaginal and sublingual modes of administration in our network meta-analysis.
Conclusion:
Route of misoprostol administration does matter in reducing blood loss during abdominal myomectomy with rectal administration favored, although the data are limited for sublingual administration.
Systematic Review Registration:
PROSPERO, CRD42025637576.
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