JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v6i1.2512 jpsim.v6i1.2512 Original Research Comparing Vaginal Misoprostol with Intraoperative Oxytocin Infusion in Blood Loss during Abdominal Myomectomy Mansoor Ammara Javed Hina gold_roshni@yahoo.com * Naeem Maryum Noureen Saima Ahmed Mian Waheed Hassan Saleha Gujranwala Medical College Govt Sardar Begum Teaching Hospital Services Hospital, Lahore Watim Medical College & General Hospital Rawalpindi *Correspondence: Hina Javed (gold_roshni@yahoo.com) 10 03 2025 2025 6 1 56 59 20 04 2024 05 06 2024 21 02 2025 Copyright © 2025 The Author(s) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To compare a single dose of vaginal misoprostol versus oxytocin infusion in terms of mean blood loss during abdominal myomectomy.

 Methodology

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

 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, BMI

 Conclusion

During abdominal myomectomy, a single dose of vaginal misoprostol is more effective than oxytocin infusion for reducing blood loss.

 Keywords Intraoperative blood loss Myomectomy Oxytocin Uterine fibroids Ethics Statement

Ethics committee: Institutional Review Board, Gujranwala Medical College, Gujranwala, Pakistan. Approval number: 13/GMC.

 References Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, et al. The management of uterine leiomyomas. J Obstet Gynaecol Canada. 2015;37(2):157-78. Mostafa-Gharabaghi P, Alizadeh S, Atashkhoye S, Sayyah-Melli M, Jafari-Shobeiri M, Ouladsahebmadarek E, et al. Comparing the outcomes and side effects of administration of a single preoperative dose of vaginal misoprostol with intraoperative Oxytocin infusion in blood loss during abdominal myomectomy. Int J Womens Health Reprod Sci. 2017;5:306-11. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Coch Database Syst Rev. 2014; 10.1002/14651858.CD005355.pub5. Srivastava S, Mahey R, Kachhawa G, Bhatla N, Upadhyay AD, Kriplani A. Comparison of intramyometrial vasopressin plus rectal misoprostol with intramyometrial vasopressin alone to decrease blood loss during laparoscopic myomectomy: Randomized clinical trial. Eu J Obstet Gynecol Reprod Biol. 2018;228(2):279-83. Aslan Çetin B, Aydoğan Mathyk B, Köroğlu N, Soydar A, Demirayak G, Çift T. Oxytocin infusion reduces bleeding during abdominal myomectomies: a randomized controlled trial. Arch Gynecol Obstet. 2019;299(2):151-7. Atashkhoei S, Fakhari S, Pourfathi H, Bilehjani E, Garabaghi P, Asiaei A. Effect of oxytocin infusion on reducing the blood loss during abdominal myomectomy: a double‐blind randomised controlled trial. Int J Obstet Gynaecol. 2017;124(2):292-8. Nazir Q, Habib S, Sultana R, Noor MM, Parveen Z. Success and safety of misoprostol for treatment of early pregnancy failure. J Ayub Med Col Abbottabad. 2018;30(2):245-7. Abdel‐Hafeez M, Elnaggar A, Ali M, Ismail AM, Yacoub M. Rectal misoprostol for myomectomy: A randomised placebo‐controlled study. Aus NZ J Obstet Gynaecol. 2015;55(4):363-8. Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S. Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Min Invas Gynecol. 2013;20(3):335-45. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod. 2001;16(4):770-4. Alptekin H, Efe D. Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy. Clin Exp Obstet Gynecol. 2014;41(4):440-4. Saha MM, Biswas SC, Alam H, Kamilya GS, Mukhopadhyay M, Mondal S. Assessment of blood loss in abdominal myomectomy by intramyometrial vasopressin administration versus conventional tourniquet application. J Clin Diag Res. 2016;10(5):QC10. Shokeir T, Shalaby H, Nabil H, Barakat R. Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study. Eu J Obstet Gynecol. 2013;1(166):61-4. Afolabi MA, Ezeoke GG, Saidu R, Ijaiya MA, Adeniran AS. Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial. J Turk German Gynecol Assoc. 2019;20(1):23. Kanthi JM, Sumathy S, Sreedhar S, Rajammal B, Usha M, Sheejamol V. Comparative study of cesarean myomectomy with abdominal myomectomy in terms of blood loss in single fibroid. J Obstet Gynecol India. 2016;66(3):287-91. Pundir J, Walawalkar R, Seshadri S, Khalaf Y, El-Toukhy T. Perioperative morbidity associated with abdominal myomectomy compared with total abdominal hysterectomy for uterine fibroids. J Obstet Gynaecol. 2013;33(7):655-62.