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Martin-Hirsch, P.P.L., and Bryant, A. (2013). Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews, 2013, CD001421.
STUDY PURPOSE: To assess safety and efficacy of interventions used to prevent blood loss during treatment of cervical intraepithelial neoplasia (CIN)
TYPE OF STUDY: Meta-analysis and systematic review
Search Strategy
DATABASES USED: CENTRAL, MEDLINE, EMBASE
INCLUSION CRITERIA: Randomized, controlled trail; women with proven CIN undergoing surgical treatment
EXCLUSION CRITERIA: None specified
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 1,225
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Evaluated for risk of bias; no specific grading for quality is reported.
Sample Characteristics
FINAL NUMBER STUDIES INCLUDED: 12
TOTAL PATIENTS INCLUDED IN REVIEW: 1,512
SAMPLE RANGE ACROSS STUDIES: 48–230
KEY SAMPLE CHARACTERISTICS: Women with CIN undergoing excision or biopsy procedures
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results
Vasopressin versus placebo: One trial showed significant reduction in blood loss (MD -100.9, p < 0.00001). One trial examined selective bleeding and showed a significant reduction with vasopressin (RR = 0.4, p < 0.0001)
Tranexamic acid (TA) versus placebo: One trial showed reduction in postoperative blood loss with TA (MD -55.6, p < 0.0001). Analysis of two trials showed no meaningful difference in the risk of primary hemorrhage (RR = 1.24), and across four trials, there was significantly reduced risk of secondary hemorrhage with TA (RR = 0.23, p = 0.00017).
Vaginal pack with Monsel’s solution: Vaginal packs were associated with significant reduction in perioperative blood loss and decreased risk of dysmennorhea compared with hemostatic sutures (p < 0.05).
Conclusions
Vasopressin, TA, and vaginal packs with Monsel’s solution appear to be helpful in reducing blood loss in women with CIN undergoing surgical procedures. Findings are limited because few studies exist comparing specific interventions.
Limitations
Limited number of studies included
Mostly low quality/high risk of bias studies
Nursing Implications
This review contains limited evidence; however, findings suggest that use of vasopressin, TA, and vaginal packs with Monsel’s solution may be helpful to reduce various types of procedure-related bleeding in women with CIN.