Effect of Preoperative Single Dose Misoprostol on Intraoperative Blood Loss during Abdominal Hysterectomy: A Randomized Controlled Trial

Background: Hysterectomy is the surgical removal of the uterus. It is the most frequently performed major gynaecological surgical procedure, with millions of procedures performed annually throughout the world. Hysterectomy can be performed for benign and malignant indications. Misoprostol, a synthetic analogue of prostaglandin E1, has been extensively evaluated as a uterotonic agent in obstetrics mainly for prevention and management of postpartum haemorrhage and reduction of bleeding during caesarean delivery. The purpose of this research is to evaluate the impact and efficacy of pre-operative sublingual misoprostol given in women having hysterectomy in terms of blood loss.

Results: This randomized single blind controlled trial was carried on 70 women undergoing total abdominal hysterectomy. They were randomly allocated in two equal groups: misoprostol group: patients received two tablets of Misoprostol (=200 μg) 30 minutes before operation and a control group (placebo group): patients received two tablets of Placebo 30 minutes before operation.

Haemoglobin and Haematocrit reductions were significantly lower among misoprostol group than among placebo group. Blood loss was significantly lower among misoprostol group than among placebo group. The most common indication for hysterectomy was a fibroid, dysfunction uterine bleeding and, adenomyosis. The fibroid was the most significant for the effect of misoprostol in decreasing blood loss, haemoglobin and haematocrit during abdominal hysterectomy more than adenomyosis and dysfunction uterine bleeding.

Conclusions: A single preoperative dose of 400 μg of misoprostol administered 30 minutes before abdominal hysterectomy resulted in a significant reduction of blood loss.