Efficacy and Safety of Vaginal Misoprostol versus Intravenous Tranexamic Acid in Blood Loss reduction during Abdominal Myomectomy: A Randomized Clinical Trial

Background & Objective: Uterine leiomyomas, also known as myomas or fibroids, are the most common pelvic tumors affecting females. The present stduy was conducted with aim to compare the efficacy and safety of vaginal misoprostol vs. IV Tranexamic Acid (TXA) in reducing intraoperative blood loss during open myomectomy.Materials & Methods: This double-blind randomized controlled trial study was conducted at the Obstetrics and Gynecology Department of Kasr Alainy Hospital, Cairo University, Egypt. A total of 39 patients undergoing open myomectomy were randomized into three groups: Tranexamic Acid (TXA), Misoprostol, and Control. The primary outcome was Estimation of Blood Loss (EBL). Secondary outcomes included the need for blood transfusion, operative time, myomectomy time, postoperative hemoglobin and hematocrit levels, side effects, and length of hospital stay. Data were analyzed using SPSS software (version 28). P<0.05 was considered significant.Results: Both TXA and Misoprostol groups had significantly lower EBL compared to the control group (P<0.001). There was no significant difference in EBL between the TXA and Misoprostol groups (P=1.000). Both groups had similar rates of blood transfusion (P=0.890). TXA and Misoprostol groups had significantly lower postoperative hemoglobin and hematocrit compared to the control group (P<0.001). Operative and myomectomy times were significantly shorter in the treatment groups (P<0.05). Postoperative stay was similar across the groups (P=1.000).Conclusion: Both TXA and Misoprostol are effective and safe in reducing blood loss during myomectomy. There is no significant difference in efficacy between the two agents.