Preoperative Rectal Misoprostol in Reducing Blood Loss during a Total Abdominal Hysterectomy: A Randomized Double-Blinded Controlled Trial Study

Main Article Content

Manasicha Pongsamakthai
Worasuda Boonsith

Abstract

Background and Objective: To compare the blood loss during a total abdominal hysterectomy of the benign uterine disease with preoperative rectal misoprostol administration and a placebo.


Material and Methods: One hundred–twenty patients over 18 years of age, who diagnosed of the benign uterine disease and underwent a total abdominal hysterectomy with or without adnexal surgery, were included from November 2019 to June 2021. The participants were randomized and allocated to undergo either the preoperative administration of the 400 micrograms rectal misoprostol (58 patients) or the placebo (57 patients). This randomized controlled trial recorded the intra-operative blood loss, blood transfusion requirement, operative time, hospital stay, and incidence of all side effects.


Results: The median (IQR) intra-operative blood loss was 162.0 (50.5-308.0) ml for the misoprostol group and 160.0 (50.0-309.0) ml for the placebo group was not statistically significant difference (p = 0.910). The misoprostol group demonstrated lower blood transfusion requirements, operative times, hospital stay, and incidence of side effects than those of the placebo group; but there were no statistically significant differences.


Conclusion: Pre-operative rectal misoprostol administration cannot reduce operative blood loss during a total abdominal hysterectomy.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Pongsamakthai M, Boonsith W. Preoperative Rectal Misoprostol in Reducing Blood Loss during a Total Abdominal Hysterectomy: A Randomized Double-Blinded Controlled Trial Study. SRIMEDJ [Internet]. 2022 Aug. 30 [cited 2023 Feb. 7];37(4):361-6. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/254393
Section
Original Articles

References

Geethamala K, Murthy VS, Vani BR, Rao S. Uterine Leiomyomas: An ENIGMA. J Midlife Health. 2016;7(1):22–7.

Borah BJ, Nicholson WK, Bradley L, Stewart EA. The Impact of Uterine Leiomyomas: A National Survey of Affected Women. Am J Obstet Gynecol. 2013 Oct;209(4):319.e1-319.e20.

Pandey D, Sehgal K, Saxena A, Hebbar S, Nambiar J, Bhat RG. An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India. Int J Reprod Med. 2014;273-9.

Harris WJ. Early Complications of Abdominal and Vaginal Hysterectomy. Obstetrical & Gynecological Survey. 1995 Nov;50(11):795–805.

Abdel-Hafeez M, Elnaggar A, Ali M, Ismail AM, Yacoub M. Rectal misoprostol for myomectomy: A randomized placebo-controlled study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2015;55(4):363–8.

Chavez NF, Stewart EA. Medical Treatment of Uterine Fibroids. Clinical Obstetrics and Gynecology. 2001 Jun;44(2):372–84.

Iavazzo C, Mamais I, Gkegkes ID. Use of misoprostol in myomectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015 Dec 1;292(6):1185–91.

Berard V, Fiala C, Cameron S, Bombas T, Parachini M, Gemzell-Danielsson K. Instability of Misoprostol Tablets Stored Outside the Blister: A Potential Serious Concern for Clinical Outcome in Medical Abortion. PLOS ONE. 2014 Dec 15;9(12):e112401.

Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: Pharmacokinetic profiles, effects on the uterus, and side-effects. International Journal of Gynecology & Obstetrics. 2007;99(S2):S160–7.

Khan R-U, El-Refaey H, Sharma S, Sooranna D, Stafford M. Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynecol. 2004 May;103(5 Pt 1):866–70.

Naib JM, Naveed P, Fatima S. Pre-operative use of misoprostol in major gynecological surgeries. Journal of Medical Sciences (Peshawar). 2013 Oct 1;21:171–3.

Tabatabai A, Karimi-Zarchi M, Meibodi B, Vaghefi M, Yazdian P, Zeidabadi M, et al. Effects of a single rectal dose of Misoprostol prior to abdominal hysterectomy in women with symptomatic leiomyoma: a randomized double-blind clinical trial. Electron Physician. 2015 Oct 19;7(6):1372–5.

Maneerat P, Tongmai S. Rectal Misoprostol in Women Undergoing Myomectomy for Intraoperative Blood Loss Reduction: A double-blinded randomized placebo-controlled study. Thai Journal of Obstetrics and Gynaecology. 2019 Jun 30;88–99.

Khan QQ, Liaqat N, Shafqat T, Bawar S. Efficacy of preoperative misoprostol in reducing hemorrhage during abdominal myomectomy. Journal of Ayub Medical College Abbottabad. 2020 Apr 15;32(2):198–203.

Park H, Yoon BS, Seong SJ, Kim JY, Shim JY, Park CT. Can misoprostol reduce blood loss in laparoscopy-assisted vaginal hysterectomy? Aust N Z J Obstet Gynaecol. 2011 Jun;51(3):248–51.

Chai J, Hon E, Li C-F, Pun T-C, Yeung S-B, Ho P-C. A pilot study of pre-operative misoprostol in reducing operative blood loss during hysterectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011 Sep 1;158(1):72–5.