الفهرس | Only 14 pages are availabe for public view |
Abstract Background: Uterine fibroids have rich blood supply which may result in intensive bleeding during the myomectomy procedure. Blood transfusion can be required in up to 20% of the women during abdominal myomectomy and may require hysterectomy in up to 2% of patient undergoing abdominal myomectomy. A number of interventions have been introduced to reduce blood loss during myomectomy and medical agents are always an attractive option to arrest haemorrhage. Objective: To compare the effectiveness of a single preoperative dose of vaginal Misoprostol, intraoperative Oxytocin infusion, intravenous Carbetocin and pericervical tourniquet for the reduction of blood loss at the time of open abdominal myomectomy. Methods: Between October 2020 and February 2022, 120 women were recruited from the outpatient gynaecological clinic in Kasr AlAiny Training Hospital. All patients presented with symptomatic intramural, submucous or subserous myoma and were candidates for open abdominal myomectomy. Patients were randomized into one of four groups (30 in each group): Misoprostol group (will receive two tablets of 200µg misoprostol administered into the posterior fornix of the vagina 1 hour before the onset of surgery), Oxytocin group (an infusion of 30 IU oxytocin in 500 ml normal saline started and continued during myomectomy), Carbetocin group (will receive 100 μg IV Carbetocin (1ml) [Pabal, Ferring (UK)] in 5 ml saline over 1 minute just before skin incision) and Tourniquet group (using a Foley catheter size 18, which will be firmly tied at the level of the cervico-isthmic junction of the uterus before the uterine incision). Standard technique of performing open abdominal myomectomy will be used. Intraoperative blood loss (ml), postoperative blood loss in drain and total estimated blood loss were calculated and recorded .The 4 groups were compared regarding the need for blood transfusion, preoperative and postoperative haemoglobin and haematocrit values (was measured on 24 hours before and 24 hours after surgery), Operation time (measured from incision of first myoma to serosal closure of last myoma wound) and post-operative hospital stay. |