What question did this study set out to answer?

This review aims to evaluate the effectiveness of different routes of misoprostol in reducing intraoperative blood loss during myomectomies.

February 21, 2026Open Access

The Route of Misoprostol in Reducing Blood Loss for Transperitoneal Myomectomies: A Systematic Review and Meta-analysis

Key Points

This review aims to evaluate the effectiveness of different routes of misoprostol in reducing intraoperative blood loss during myomectomies.
Conducted a systematic search across multiple databases up to June 2024.
Screened titles and abstracts, followed by full-text reviews for eligibility.
Performed network meta-analysis on identified studies to compare blood loss outcomes.
Rectal administration resulted in the largest mean reduction in blood loss of 152.43 mL.
Vaginal administration reduced blood loss by 69.46 mL, with statistical significance.
Sublingual administration showed no significant effect compared to other methods.

Abstract

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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