Effects of Misoprostol in Reducing Blood Loss during Abdominal Myomectomy in Nigeria

Abstract

Background: Despite using a tourniquet to reduce bleeding during abdominal myomectomy, the procedure is still complicated by  significant intraoperative bleeding.

Aim: To determine whether misoprostol and tourniquet compared with tourniquet alone would  significantly reduce bleeding during abdominal myomectomy at two tertiary hospitals in Enugu.

Materials and Methods: This study is an  open-label randomized controlled trial. A total of 126 consenting participants were recruited from women booked for abdominal  myomectomy at the study centers over 7 months. They were randomized into groups A (vaginal misoprostol 400 µg) and B (no  misoprostol) one hour before surgery. Intraoperatively, all participants had a tourniquet application. Intraoperative and postoperative  blood loss was compared between the two groups. Descriptive and inferential analyses were carried out using IBM SPSS Version 22.0. A  P- value of < 0.05 was considered statistically significant.

Results: An intention-to-treat analysis was carried out. All 63 participants (100%)  and 56 (90%) completed the study according to the protocol in groups A and B, respectively. Socio-demographic characteristics were not  significantly different in both groups. The mean intraoperative blood loss in the “misoprostol group” (522.6 ± 127.91 ml) was significantly  lower than in the “no‑misoprostol group” (583.5 ± 186.20 ml), with P = 0.028. The difference in mean hemoglobin (g/dl) was lower in the  “misoprostol group” than in the “no-misoprostol group” (1.3 ± 0.79 vs. 1.9 ± 0.89, P < 0.001). The mean 48 hours postoperative blood loss  (ml) between the two groups was 323.8 ± 221.44 vs. 549.4 ± 519.72), with P = 0.001.

Conclusion: Among women receiving tourniquet  during myomectomy in Enugu, the additional use of vaginal misoprostol 400 µg significantly reduced intraoperative blood loss.