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Meta-Analysis
. 2013 Dec 4;2013(12):CD001421.
doi: 10.1002/14651858.CD001421.pub3.

Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia

Pierre P L Martin-Hirsch  1 , Andrew Bryant
Affiliations
Meta-Analysis

Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia

Pierre P L Martin-Hirsch et al. Cochrane Database Syst Rev. .

Abstract

Background: Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss.

Objectives: To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN.

Search methods: We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to November 2012. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.

Selection criteria: Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN.

Data collection and analysis: Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses.

Main results: Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09).

Authors' conclusions: Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1: Vasopressin versus placebo, Outcome 1: Measured blood loss (ml)
1.2
1.2. Analysis
Comparison 1: Vasopressin versus placebo, Outcome 2: Subjective troublesome bleeding
1.3
1.3. Analysis
Comparison 1: Vasopressin versus placebo, Outcome 3: Bleeding requiring haemostatic sutures, Vasopressin
1.4
1.4. Analysis
Comparison 1: Vasopressin versus placebo, Outcome 4: Cervical stenosis
2.1
2.1. Analysis
Comparison 2: Tranexamic acid versus control, Outcome 1: Postoperative blood loss
2.2
2.2. Analysis
Comparison 2: Tranexamic acid versus control, Outcome 2: Primary haemorrhage
2.3
2.3. Analysis
Comparison 2: Tranexamic acid versus control, Outcome 3: Secondary haemorrhage
3.1
3.1. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 1: Perioperative blood loss (ml)
3.2
3.2. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 2: Primary haemorrhage
3.3
3.3. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 3: Secondary haemorrhage
3.4
3.4. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 4: Amenorrhoea
3.5
3.5. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 5: Dysmenorrhoea
3.6
3.6. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 6: Transformation zone not visible at colposcopy
3.7
3.7. Analysis
Comparison 3: Pack versus haemostatic suture, Outcome 7: Cervical stenosis
4.1
4.1. Analysis
Comparison 4: Cerclage suture versus electrical coagulation, Outcome 1: Duration of procedure
4.2
4.2. Analysis
Comparison 4: Cerclage suture versus electrical coagulation, Outcome 2: Primary haemorrhage
4.3
4.3. Analysis
Comparison 4: Cerclage suture versus electrical coagulation, Outcome 3: Secondary haemorrhage
4.4
4.4. Analysis
Comparison 4: Cerclage suture versus electrical coagulation, Outcome 4: Dysmenorrhoea
4.5
4.5. Analysis
Comparison 4: Cerclage suture versus electrical coagulation, Outcome 5: Unsatisfactory colposcopy
5.1
5.1. Analysis
Comparison 5: Vaginal Amino‐Cerv versus routine treatment, Outcome 1: Secondary haemorrhage
5.2
5.2. Analysis
Comparison 5: Vaginal Amino‐Cerv versus routine treatment, Outcome 2: Vaginal discharge at 2 weeks
5.3
5.3. Analysis
Comparison 5: Vaginal Amino‐Cerv versus routine treatment, Outcome 3: Vaginal discharge at 4 weeks
6.1
6.1. Analysis
Comparison 6: Prilocaine with felypressin versus lignocaine with adrenaline in LLETZ, Outcome 1: Duration of procedure
7.1
7.1. Analysis
Comparison 7: Ball electrode versus Monsel’s paste for haemostasis after LEEP, Outcome 1: Blood loss
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Update of

References

References to studies included in this review

Dane 2008 {published data only}
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Chan 2007 {published data only}
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