Background: Misoprostol is a synthetic version of prostaglandin E1, unlike its naturally occurring counterpart. Prostaglandins enhance the contractions of the myometrium, resulting in a decrease in bleeding from the myometrium.

Objective: To assess the effect of preoperative sublingual misoprostol versus a placebo on intraoperative blood loss during abdominal myomectomy.

Patients and methods: This case control study conducted on 100 patients at Damanhour Medical National Institute from October 2023 until March 2024. Results: There was no discernible disparity in the use of Vasopressin among laparoscopic & open myomectomy (p-value = 0.15) or Tranexamic Acid (p-value = 0.39). In terms of postoperative complications, in the misoprostol group, 8% of patients had nausea, 4% had vomiting, and 8% had shivering, while in the control group, 4% of patients had nausea, 6% of patients had vomiting, and 4% of patients had shivering. There was no discernible disparity in complications between the groups.

Conclusions: Our study concluded that there was a significant disparity in blood loss during surgery amongst the two groups. Our findings also indicate that administering sublingual misoprostol before surgery is an easy, easily implemented, and comfortable approach to decreasing intraoperative blood loss throughout abdominal myomectomy.