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

  • Review
  • Intervention

Authors

  • Pierre PL Martin-Hirsch,

    Corresponding author
    1. Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Gynaecological Oncology Unit, Preston, Lancashire, UK
    • Pierre PL Martin-Hirsch, Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, PR2 9HT, UK. pierre.martinhirsch@btinternet.com.

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  • Henry C Kitchener

    1. St. Mary's Hospital, Academic Unit of Obstetrics and Gynaecology, University of Manchester, Manchester, UK
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Abstract

Background

Surgical treatments for cervical intra-epithelial neoplasia are commonly associated with immediate and long term complications. This review evaluates interventions designed to reduce morbidity.

Objectives

Good surgical technique and other interventions can reduce immediate and long-term blood loss which is a common complication of surgery for cervical intra-epithelial neoplasia. The objective of this review was to assess the effect of interventions to reduce blood loss due to surgery for cervical intra-epithelial neoplasia.

Search strategy

We searched the Cochrane Gynaecological Cancer Group trials register.

Selection criteria

Randomised and quasi-randomised trials of vasopressin, tranexamic acid, haemostatic sutures or Monsel's solution in women who have had surgery for intra-epithelial neoplasia.

Data collection and analysis

Two reviewers independently abstracted data.

Main results

Seven trials were included. Vasopressin had a beneficial effect on peri-operative bleeding. Prophylactic tranexamic acid reduced haemorrhage after knife and laser cone biopsy. Packing with Monsel's solution resulted in less peri-operative blood loss and secondary haemorrhages than routine suturing. Elective suturing also appeared to increase the risk of amenorrhoea and dysmenorrhoea. Vaginal packing increased satisfactory colposcopy rates at follow-up and reduced post-surgical stenosis.

Authors' conclusions

Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, which is used under local rather than general anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are not enough 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.

Plain language summary

Interventions for preventing bllod loss during the treatment of pre-cancerous abnormalities (cervical intraepithelial neoplasia)

Immediate blood loss during surgery for cervical intraepithelial neoplasia can be reduced by good surgical technique and sometimes by using vasopression, transexamic acid or stitches. Surgery for pre-cancerous cervix lesions (cervical intraepithelial neoplasia) often causes significant bleeding during surgery or within 14 days. This review found good surgical technique can reduce immediate blood loss and bleeding can also be reduced by some drugs. Vasopressin reduces blood flow by constricting blood vessels. Transexamic acid reduces blood loss after knife and laser cone biopsy. Stitches also reduce blood loss but can interfere with later visual examination of the cervix.