EFFICACY OF PREOPERATIVE MISOPROSTOL IN REDUCING HEMORRHAGE DURING ABDOMINAL MYOMECTOMY
AbstractBackground Uterine myomas are most common non-cancerous tumours in reproductive period. The fertility preserving surgery, i.e., myomectomy as compared to hysterectomy, is associated with massive blood loss due to dissection of huge fibroids making it technically difficult procedure. Misoprostol (a uterotonic) is an effective option amongst different interventions used to reduce intraoperative blood loss during myomectomy. This randomized control trial investigated effectiveness of single dose of rectal misoprostol given preoperatively in reducing intraoperative blood loss during abdominal myomectomy. Methods Fifty Patients undergoing abdominal myomectomy were selected for the study. Twenty-five patients were given 800 micrograms misoprostol per rectally half an hour before surgery while rest received placebo, i.e., control group. Number and weight of surgical packs were recorded both Pre and post operatively to assess blood loss. Preoperative and 24 hrs postoperative haemoglobin was also recorded. Data analysed by SPSS-20. Results: Mean of age, parity and myoma size were not statistically different between the two groups. However intraoperative blood loss (as measured by weighing and counting number of swabs used) and postoperative haemoglobin after 24 hours were significantly different between two groups with p-value <0.01. Conclusion: Single dose of misoprostol given preoperatively via rectal route is effective in reducing intraoperative blood loss during abdominal myomectomy. Misoprostol must be used in different doses and routes in order to investigate its effectiveness in reducing intraoperative blood loss.Keywords: Preoperative misoprostol; Abdominal myomectomy; Intra operative ;Blood loss
Parker WH. Uterine myomas: management. Fertil Steril 2007;88(2):255–71.
Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001;(2):CD000547.
LaMorte AI, LaIwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynaecol 1993;82:897–900.
Negh N, Belli A, Morgan R, Manyodal. Pre-myomectomy uterine embolization minimizes operative blood loss. Br J Obstet Gynaecol 2004;111(10):1139–40.
Kimura T, Kusui C, Matsumura Y, Ogita K, Isaka S, Nakajima A. Effectiveness of hormonal tourniquet by vasopressin during myomectomy through vasopressin Via receptor ubiquitously expressed in the myometrium. Gynaecol Obstet Invest 2002;54(3):125–31.
Liu W, Tzeng C, YI-Jen C, Wang P. Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids. Fertil Steril 2004;82(1):205–10.
Amato P, Roberts AC. Transient ovarian failure (a complication of uterine artery embolization). Fertil Steril 2001;75(2):438–9.
Choksuchat C. Clinical use of misoprostol in nonpregnant women: Review article. J Minim Invasive Gynaecol 2010;17(4):449–55.
Fletcher H, Frederick J, Hardie M, Simeon D. A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 1996;87(6):1014–8.
Allen RMO, Brien B. Uses of misoprostol in obstetrics and gynaecology. Rew Obstetrics Gynecol 200;2(3):159–68.
Higgins JPT, Green S, Cochrane Collaboration, editors. Cochrane handbook for systematic reviews of interventions. Chichester, England; Hoboken, NJ: Wiley-Blackwell, 2008; p.649.
Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids (systematic review). Cochrane Menstrual Disord Subfertility Group Cochrane Database Syst Rev 2004;3.
Khan RU, EI- Rafaey H, Sharma S, Sooranna D, Stafford M. Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynaecol 2004;103(5 Pt 1):866–70.
Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 2003;79(5):1207–10.
Zieman M, Fong SK, Beniwitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral and vaginal administration. Obstet Gynaecol 1997;90(1): 88-92
Tang OS, Schweer H, Seyberth HW, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod 2002;17(2):332–6.
Naib JM, Naveed P, Fatima S. Pre-operative use of misoprostol in major gynaecological surgeries. J Med Sci 2013;21(4):171–3.
Ishrat S, Islam F. Misoprostol in obstetrics and gynaecology-A clinical review. J Dhaka Med Coll 2009;18(1):75–8.
Vahdat M, Kashanian M, Asadollah S, Yazdkhasti P, Nikravan N. The effect of misoprostol on intraoperative blood loss after myomectomy. Int J Reprod Contracept Obstet Gynaecol.2017;4(3):776–9.
Browning RM, Trentino K, Nathan EA, Hashemi N. Preoperative anemia is common in patients undergoing major gynaecological surgery and is associated with fivefold increased risk of transfusion. Aust N Z J Obstet Gynaecol 2012;52(5):455–9.
Kongnyuy EJ, Winsonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2014;8:CD005355.
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