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• W2791683990 abstract "To identify risk factors for blood loss >300 cc and prevalence of transfusion at the time of myomectomy, with the goal of identifying patients who need more aggressive blood loss control. A case-control study comparing patients who had an estimated blood loss (EBL) of ≤300 cc vs >300 cc at the time of myomectomy. We identified 394 myomectomies (excluding hysteroscopic) at an academic institution from January 2013 - December 2016. They were divided into cases (EBL >300 cc) and controls (EBL ≤300 cc). Patient charts were reviewed to collect data summarized in Tables 1 and 2. Chi-squared and Fisher exact analyses were used to compare categorical variables. For continuous variables, means were compared via t-test if normally distributed (per Shapiro-Wilk test) and medians were compared via Rank Sum test if not. Uterine size in centimeters (by imaging) and in weeks (by examination), was larger in the case group, with a mean of 15.5 cm / 17.6 weeks as compared to 11.4 cm / 13.2 weeks in the control group (Table 1). Age, BMI, and surgical history were similar. The distribution of surgical approaches was different, with 57.3% vs 28.9% of patients undergoing a laparotomy (Table 2). A greater number of fibroids (8 vs 3) and fibroid mass (438g vs 188g) were removed in the case group. Methods to reduce blood loss (e.g., tourniquet and misoprostol), were more commonly used when EBL was >300 cc. Vasopressin was widely used in both groups while cell saver technology was rarely utilized (6 cases). Blood transfusion was common in the case group, with 19.1% and 32.8% of patients receiving a blood transfusion intra-operatively and post-operatively, respectively, and rarely given in the control group. This study suggests risk factors for EBL >300 cc at the time of myomectomy, including uterine size, fibroid burden, and laparotomy. Past studies report blood transfusion rates of 10% or less with an average EBL of 200-300 cc. Our data were not consistent with this, in spite of more liberal tourniquet and misoprostol use in the high blood loss group. The growth of a minimally-invasive surgery (MIS) group at our institution has recruited women with larger uteri, so in spite of the increased use of a MIS approach, we anticipate continued high blood loss. This study identifies the need for more aggressive blood loss control measures, such as routine misoprostol and cell saver use, in high-risk groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2791683990 date "2018-02-01" @default.
• W2791683990 modified "2023-09-25" @default.
• W2791683990 title "75: Risk factors for blood loss and prevalence of transfusion at the time of myomectomy" @default.
• W2791683990 doi "https://doi.org/10.1016/j.ajog.2017.12.094" @default.
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