ABSTRACT
Background: Myomectomy is a common gynecological procedure that can be approached, depending on fibroid location, hysteroscopically or abdominally. The impact of excessive blood loss can range from anemia and blood transfusion to hysterectomy, prolonged hospital stay and potentially death. In addition to preoperative patient optimization, it is crucial to be proactive to minimise intraoperative blood loss.
Objective: To compare the efficacy of preoperative administration of dinoprostone 21 mg versus 400 ug misoprostol vaginally in reducing the amount of blood loss during abdominal myomectomy.
Patients and methods: The current study was a prospective randomized double blind controlled study. The study included 90 patients complaining of uterine myoma and indicated for myomectomy selected from the outpatient clinic of Al-Azhar and the outpatient clinic of Al-Eman General Hospital- Assiut. Patients were divided into three equal groups: Group I received 21 mg of Dinoprostone vaginally 2 hours before surgery, Group II received 400 ug of Misoprostol vaginally 2 hours before surgery, and Group III received a placebo vaginally 2 hours before surgery.
Results: Estimated intra-operation blood loss was highest among the control group as compared to the Dinoprostone and Misoprostol groups. However, the estimated intra-operation blood loss difference between Dinoprostone and Misoprostol groups was statistically non-significant. Need for intra-operative blood transfusion was significantly highest in the control group (9 cases vs. 3 cases in Dinoprostone and 3 cases in Misoprostol groups). The number of transfused blood units ranged from one to three units without a statistically significant difference between the three studied groups. Post-operative hospital stay ranged from one to three days with non-statistically significant differences between the three studied groups.
Conclusion: The use of vaginal misoprostol or dinoprostone is an effective method to reduce intraoperative hemorrhage during abdominal myomectomy. Also, a single, preoperative dose of dinoprostone administered intravaginally could be safe and a reliable method to help decrease blood loss during abdominal myomectomy.