The efficacy of a single preoperative dose of sublingual misoprostol in reducing operative blood loss during abdominal hysterectomy done for symptomatic fibroid uterus

Abstract

Hysterectomy done for fibroid uterus is a commonly performed gynaecological surgery and
intraoperative hemorrhage is a critical complication encountered that necessitates blood
transfusions. Various medications are being used intraoperatively to reduce blood loss.
Misoprostol, a PG E1 analogue widely used uterotonic agent, has shown potential in
minimising blood loss and is safer than presently used ones.
Aim:
The purpose of the study was to evaluate sublingual misoprostol's safety and effectiveness in
lowering intraoperative blood loss
Material and Methods:
A randomized, double-blind controlled trial conducted at Rajiv Gandhi Government Women
and Children Hospital, Puducherry, from January 2014 to August 2017.Seventy women with
symptomatic fibroids undergoing total abdominal hysterectomy (TAH) were randomised into two groups: the misoprostol group (n=35) received 400 mcg sublingually 30 minutes before
surgery, while the placebo group (n=35) received a placebo. Intraoperative blood loss,
hemoglobin (Hb) levels preoperatively and postoperatively, along with adverse effects, were
documented.
Results:
The misoprostol group exhibited significantly lower mean intraoperative blood loss (270.09 ±
170.87 ml) compared to placebo group (455.49 ± 242.42 ml; p=0.0001). Although reduction
in postoperative hemoglobin levels was not statistically significant (p=0.32), misoprostol
effectively reduced the incidence of higher blood loss categories, with no cases of blood loss
exceeding 750 ml
Conclusion:
Sublingual misoprostol significantly reduces intraoperative blood loss during abdominal
hysterectomy without severe adverse effects. Also, its affordability makes it a valuable tool in
resource-limited settings. Further studies are warranted to optimize its clinical application.