Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial

Muhibat A. Afolabi,Abiodun S. Adeniran,Munirdeen A. Ijaiya,Rakiya Saidu,Grace G. Ezeoke

doi:10.4274/jtgga.galenos.2018.2018.0049

Muhibat A. Afolabi, Abiodun S. Adeniran + Show 3 more

Open Access

https://doi.org/10.4274/jtgga.galenos.2018.2018.0049

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Abstract

Objective:To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy.Material and Methods:A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility in Nigeria. Participants were recruited after they gave informed consent and randomized into group I (single dose 400 μg vaginal misoprostol one-hour before surgery) and group II (intraoperative pericervical hemostatic tourniquet). Eighty participants (40 in each group) were recruited. Uterine size was measured in centimeters above the pubic symphysis, and blood loss estimation involved direct volume measurement and gravimetric methods. The main outcome measures were intraoperative blood loss, blood transfusion, and recourse to hysterectomy. Ethical approval and trial registration were obtained; the data were analyzed using the SPSS software version 21.0; p<0.05 was considered significant.Results:Participants in group I had higher mean intraoperative blood loss (931.89±602.13 vs 848.40±588.85 mL, p=0.532), intra-operative blood transfusion rates (60 vs 55%; p=0.651) and mean units of blood transfused (1.30±1.20 vs 1.20±1.30; p=0.722) compared with group II. The mean uterine size (19.50±6.93 vs 20.05±6.98 cm; p=0.725) and number of fibroid nodules (11.25±7.99 vs 11.45±8.22; p=0.912) were comparable. The change in post-operative hematocrit was 2.66±2.21% vs 3.24±2.85% (p=0.315) and post-operation blood transfusion was 2.5 vs 5% (p=0.556). There was no recourse to hysterectomy in either of the study groups. While adverse effects of misoprostol occurred in 5 (12.5%) participants of group I.Conclusion:The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative hemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy.

Highlights

Uterine leiomyoma is the most common benign genital tract tumor in women of reproductive age (1) and the most frequent reason for gynecologic consultation in most Nigerian hospitals (2,3)
Abdominal myomectomy is often preferred to the laparoscopic route in the presence of large and multiple uterine leiomyoma (7)
The study evaluated the effectiveness of perioperative misoprostol administered vaginally compared with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy

Summary

Introduction

Uterine leiomyoma is the most common benign genital tract tumor in women of reproductive age (1) and the most frequent reason for gynecologic consultation in most Nigerian hospitals (2,3). It is more common among black women (4) with an incidence of 3.0% to 29.3% (2,5). Symptomatic uterine fibroid can adversely affect the quality of life, especially in low resource countries where patients often present late with huge masses and anemia (2,3,5). The definitive treatment for symptomatic leiomyoma is hysterectomy; for women who desire future fertility or preservation of the uterus, myomectomy is a common option (6). Abdominal myomectomy is often preferred to the laparoscopic route in the presence of large and multiple uterine leiomyoma (7)

24 Reducing blood loss in myomectomy

Material and Methods

Results

Discussion