Vaginal Misoprostol Versus Uterine Artery Ligation in Reducing Blood Loss in Cases of Myomectomy: Randomized Controlled Study

Abstract Background Many techniques are used to reduce blood loss during myomectomy; preoperative measures such as correction of preoperative anemia associated with menorrhagia may be treated with iron supplementation, use of gonadotropin [GHC] triggers prior to surgery. Intra- operative measures as use of tourniquet around the uterus during the operation, injections of vasopressin or other vasopressors as epinephrine in the uterine muscle and use of ecbolic [misoprostol, oxytocin, etc.]. Misoprostol is a prostaglandin E1 analog that causes regular uterine contraction within 1 to 2 hours following vaginal administration, lasting up to 6 hours. Hence, postoperative blood loss due to uterine relaxation could be prevented for up to 6 hours. In addition, misoprostol is cheap, readily available, and stable at room temperature; therefore, its use may be highly favored in developing countries. Objective To compare preoperative vaginal misoprostol with intraoperative peri-cervical hemostatic uterine artery ligation in reducing blood loss during myomectomy. Methods This study is a randomized controlled study, which conducted at Ain shams University Maternity Hospital. The study included 64 women attending outpatient clinic admitted for elective abdominal myomectomy divided into two groups: Group A: (misoprostol group) was included women who were given 400μg misoprostol vaginally 1 hour before myomectomy operation. Group B: (uterine artery ligation group); was included women where intraoperative cervical uterine artery ligation were done during myomectomy. Results There was no significant difference regarding age, BMI, Smoking, and gravidity between the studied groups. There was no significant difference regarding HB, HCT, Towels’ Weight, and Suction Bottle weight pre and post-operative between the studied groups. There was no statistically significant difference regarding Blood Loss, and need for blood transfusion between the studied groups. There was no statistically significant difference regarding Nausea. Nausea and vomiting, wound infection, and fever, and between the studied groups. There were 6.3% had Nausea, 3.1% had Shivering, and 3.1% had Vomiting in Vaginal Misoprostol group. Conclusion Based on our finding we conclude that, comparable effectiveness in reducing blood loss during abdominal myomectomy for peri-operative vaginal misoprostol and intra- operative uterine artery ligation. Therefore, the choice between application of both techniques is left to the surgeon’s surgical capabilities and preference. Further research and long-term follow-up studies are warranted to validate these findings.