Comparative study of preoperative misoprostol versus intraoperative pericervical hemostatic tourniquet in reducing blood loss in cases of myomectomy

Abstract

Objective The aim was to compare preoperative vaginal misoprostol versus intraoperative per-cervical hemostatic tourniquet in reducing blood loss during myomectomy. Patients and methods This prospective randomized control study was conducted on 60 patients who were experiencing symptomatic uterine myoma and underwent abdominal myomectomy at the Obstetrics and Gynecology Department of Al-Zahraa University Hospital from August 2020 to February 2021. The patients were divided into two groups: group A (misoprostol group) included 30 women who received 400 mg misoprostol vaginally 1 h before myomectomy operation, and group B (tourniquet group) included 30 women who underwent intraoperative per-cervical infant feeding tube form of tourniquet, during myomectomy. The intraoperative comments on type, site, size of fibroid, operation time, amount of blood loss, and blood transfusion need were recorded. The main outcome measures were as follows: primary outcome included the estimated blood loss and postoperative hemoglobin (Hb) and hematocrit (HCT) level, and secondary outcome included the possibility of blood transfusion and operative time. Results There was a significantly shorter duration of operation in tourniquet group (47.5±4.7) compared with misoprostol group (53.0±6.9) (P=0.001). There was significant less blood loss in the tourniquet group compared with the misoprostol group (375.0±96.3 and 440±78, respectively) (P=0.006). There was a statistically significant difference between the studied groups regarding blood transfusion, as eight patients (26.7%) of misoprostol group received blood transfusion, whereas only two patients (6.7%) of tourniquet group received blood transfusion (P=0.038). There was insignificant difference in baseline (preoperative) Hb and HCT levels between the study groups. However, there was a statistically significant difference between the study groups regarding the postoperative Hb and HCT, which were higher in the tourniquet group compared with the misoprostol group (33.7±2.6 and 32.2±2.4, respectively; P=0.033). Conclusion Fastening a tourniquet at per-cervical area during abdominal myomectomy reduced the intraoperative blood loss significantly compared with preoperative misoprostol, with shorter operative time with decreased incidence of risk of blood transfusion.