Comparing Vaginal Misoprostol with Intraoperative OxytocinInfusion in Blood Loss during Abdominal Myomectomy

In the reproductive age more than 15% of the women are found to have uterine fibroid(s) which is one of the most common pelvic tumors.The treatment is not always necessary when it is asymptomatic.Surgical intervention is necessary when it is associated with infertility, recurrent miscarriages, urinary problems and menstrual 1 problems.With the advancement in medical fields many different modalities have been used to tackle this problem like myolysis, uterine artery embolization, mini-mally invasive surgical procedures etc. but the traditional open surgical procedures are the mainstay of treatment 2 in most of the countries.Open surgical procedure i.e. myomectomy is associated with blood loss and subsequent anemia.To reduce the blood loss during myomectomy various modifications and interventions have been used like intramyometrial vasopressin, oxytocin, chemical dissection, use of epinephrine, various tourni-3-5 quets etc. Misoprostol and oxytocin are used widely to enhance uterine contractions and to decrease blood AbstractObjective: To compare a single dose of vaginal misoprostol versus oxytocin infusion in terms of mean blood loss during abdominal myomectomy.Methods: This Randomized controlled trial was conducted on 100 females from OPD department of Gynecology, District Headquarter Hospital Gujranwala during November 2019 to April 2020.Females were split randomly in two equal groups.In group A, two tablets of misoprostol i.e. 400 micrograms were given via vaginal route 20 minutes before induction of anesthesia.Twenty minutes before induction of anesthesia and during myoma excision, females in group B received 30 units of oxytocin in 1000 ml normal saline at a rate of 120 ml /min.Blood loss was measured.Data was analyzed using IBM.SPSS Version 20.Independent sample t-test was used to compare the two groups for blood loss during surgery.Statistical significance was assumed at a p value of less than <0.05. Results:The mean age of the patients was 35.69 8.162 years.The age stratification has been shown below.The mean BMI was 24.70 3.040 kg/m2.The largest dimension of the fibroid was 7.57 3.036 cm.The quantitative variables were compared among groups.There was no difference between groups in terms of age, BMI and dimension of the fibroid (p values 0.519, 0.149, 0.922 respectively).However, there was a difference among the groups regarding blood loss during surgery.The blood loss in group A was 452.04 27.461 ml and in group B was 475.62 51.752 ml (p values 0.005).The data was stratified according to age, BMI, type and location of the fibroid.The results showed there was blood loss difference among groups in the following groups only; Age <35 years, > 35 years, BMI <25 kg/m2, intramural location and fibroids dimension <7cm (p value 0.005, 0.021, 0.001, <0.0001, <0.0001). Conclusion:During abdominal myomectomy, a single dose of vaginal misoprostol is more effective than oxytocin infusion for reducing blood loss.