EFFICACY AND SAFETY OF SUBLINGUAL MISOPROSTOL IN REDUCING INTRAOPERATIVE BLOOD LOSS DURING ABDOMINAL MYOMECTOMY

Objective: To compare the effectiveness and safety of 400 mg of sublingual and per rectal Misoprostol when given 1 hour prior to abdominal Myomectomy in reducing intraoperative blood loss. Material and Methods: A quasi-experimental study involving women with uterine leiomyoma was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, including patients who underwent abdominal myomectomy. Participants were enrolled after providing informed consent and were randomly assigned to either group 1, which received 400 mg of misoprostol rectally, or group II, which received 400 mg of misoprostol sublingually one hour before surgery. A total of 48 participants were enrolled. The primary outcome measures were intraoperative blood loss and the difference between preoperative and postoperative hemoglobin levels; secondary measures included postoperative febrile morbidity, gastrointestinal complaints, and other side effects. All data were stored and analyzed using SPSS 20. A p-value of <0.05 was considered statistically significant.  Results: The mean age of patients in group 1 (per rectal) was 32.6 (± 4.8) years, and in group 2 (sublingual) it was 33.8 (± 4.5) years. The mean parity in group 1 was 1.8 (1.3), while in group 2 it was 1.3 (1.2). The mean uterine size in group 1 was 17.6 (2.3) cm, and in the per rectal group, 15.8 (2.2) cm. Blood loss during the myomectomy procedure was 342.8 (154.6) ml in group 1 and 386.5 (118.3) ml in the sublingual group. Complications of misoprostol were very rare and minor, such as nausea and uterine cramps.  Conclusion: Sublingual misoprostol is an effective and safe agent for reducing blood loss during abdominal myomectomy. When compared with the use of the same dose of per rectal misoprostol given 1 hour before surgery, it did not show a significant difference; however, the ease of administration via the sublingual route is favored and acceptable to women in the Asian community. Keywords: Sublingual Misoprostol, Intraoperative Blood Loss, Myomectomy