Skip to main content
SpringerLink
Log in

Rectal misoprostol plus perivascular vasopressin versus tourniquet to decrease blood loss during abdominal myomectomy

  • Original Article
  • Published:
Gynecological Surgery

Abstract

The aim of this study is to compare between combined preoperative rectal misoprostol plus perivascular vasopressin and tourniquet to decrease blood loss during abdominal myomectomy. In this randomized study, 104 patients were randomly allocated to receive either combined 400 μg rectal misoprostol plus perivascular vasopressin (n = 52) or tourniquet (n = 52). The main outcome measure was the operative blood loss. Secondary outcome measures included the requirement for blood transfusion, the change in hemoglobin level after operation, and incidence of complications. Blood loss was significantly greater in the group with tourniquet (375.7 ± 292.3 mL) than in the group with rectal misoprostol plus perivascular vasopressin (254.1 ± 185.4 mL) (P = 0.03). The group with tourniquet had a significant decrease in Hb level 24 h after operation (P < 0.04). Blood transfusion rate was significantly greater in the group with tourniquet (P < 0.04). The febrile morbidity was comparable in the two groups. Rectal misoprostol plus perivascular vasopressin was found to be more effective than tourniquet for decreasing blood loss during abdominal myomectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36(4):433–445

    Article  PubMed  Google Scholar 

  2. Vercellini P, Vendola N, Ragni G, Trespidi L, OldaniS CPG (1993) Abnormal uterine bleeding associated with iron-deficiency anemia: etiology and role of hysteroscopy. J Reprod Med 38:502–504

    CAS  PubMed  Google Scholar 

  3. Verkauf BS (1993) Changing trends in treatment of leiomyomata uteri. Curr Opin Obstet Gynecol 5(3):301–310

    Article  CAS  PubMed  Google Scholar 

  4. Garcia CR (1993) Management of the symptomatic fibroid in women older than 40 years of age. Hysterectomy or myomectomy? Obstet Gynecol Clin North Am 20(2):337–348

    CAS  PubMed  Google Scholar 

  5. Lethaby A, Vollenhoven B, Sowter M (2001) Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Data base Syst Rev 2:CD000547

    Google Scholar 

  6. Mukhopadhaya N, DeSilv C, ManyondaI T (2008) Conventional myomectomy. Best practice and research Clinical. Obstet Gynecol 22:677–705

    Google Scholar 

  7. Rossetti A, Paccosi M, Sizzi O, Zulli S, Mancuso S, Lanzone A (1999) Dilute ornitin vasopressin and a myomadrill for laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 6(2):189–193

    Article  CAS  PubMed  Google Scholar 

  8. Wing DA, Goharkhay N, Felix JC, Rostamkhani M, Naidu YM, Kovacs BW (2006) Expression of the oxytocin and V1a vasopressin receptors in human myometrium in differing physiologic states and following misoprostol administration. Gynecol Obstet Invest 62(4):181–185

    Article  CAS  PubMed  Google Scholar 

  9. Fletcher H, Frederick J, Simeon D, Hardie M (1996) A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 87:1014–1018

    Article  CAS  PubMed  Google Scholar 

  10. Taylor A, Sharma A, Tsirkas P, Arora R, De SpiezioSardo A, Mastrogamvrakis G et al (2005) Surgical and radiological management of uterine fibroids—a UK survey of current consultant practice. Acta Obstet Gynecol Scand 84:478–482

    Article  PubMed  Google Scholar 

  11. Wang CJ, Yuen LT, Han CM, Kay N, Lee CL, Soong YK (2008) A transient blocking uterine perfusion procedure to decrease operative blood loss in laparoscopic myomectomy. Chang Gung Med J 31:463–468

    CAS  PubMed  Google Scholar 

  12. Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W (2013) A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy. Fertil Steril 100(4):1044–9

    Article  CAS  PubMed  Google Scholar 

  13. NiroomandN HS, Tabrizi MN, Ghajarzadeh M (2015) A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial. Arch Gynecol Obstet 292:155–158

    Article  Google Scholar 

  14. Abdel-Hafeez M, Elnaggar A, Ali M, Ismail AM, Yacoub M (2015) Rectal misoprostol for myomectomy: a randomized placebo-controlled study. Aust N Z J Obstet Gynaecol 55(4):363–368

    Article  PubMed  Google Scholar 

  15. Sapmaz E, Celik H (2003) Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 79:1207–1210

    Article  PubMed  Google Scholar 

  16. Kashanian M, Vahdat M, Asadollah S, Yazdkhasti P, Nikravan N (2015) The effect of misoprostol on intraoperative blood loss after myomectomy. Int J Reprod Contracept Obstet Gynecol 4(3):776–779

    Google Scholar 

  17. Ragab A, Khaiary M, Badawy A (2014) The use of single versus double dose of intra-vaginal prostaglandin E2 “Misoprostol” prior to abdominal myomectomy. A randomized controlled clinical trial. Reprod Infertil 15(3):152–156

    Google Scholar 

  18. Tang OS, Gemell-Danielson PC (2007) Misoprostol: pharmacokinetics profile of effectson uterus and side effects. Int J Gynecol Obstet 99:5160–5167

    Article  Google Scholar 

  19. Khan RU, El-Refaey H, Sharma S, Sooranna D, Stafford M (2004) Oral, rectal, and vaginal pharmacokinetics of misoprostol. Obstet Gynecol 103:866–870

    Article  CAS  PubMed  Google Scholar 

  20. Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M (1994) Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol 101:435–437

    Article  CAS  PubMed  Google Scholar 

  21. Rasmussen H, Schwartz IL, Schoessler MA, Hochst G (1960) Studies on the mechanism of action of vasopressin. Proc Natl Acad Sci U S A 46:1278–1287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Nezhat F, Admon D, Nezhat CH, Dicorpo JE, Nezhat C (1994) Life threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. J Am Assoc Gynecol Laparosc 2:83–86

    Article  CAS  PubMed  Google Scholar 

  23. Alptekin H, Efe D (2014) Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy. Clin Exp Obstet Gynecol 41(4):440–444

    CAS  PubMed  Google Scholar 

  24. Ikechebelu JI, Ezeama CO, Obiechina NJ (2010) The use of tourniquet to reduce blood loss at myomectomy. Niger J Clin Pract 13(2):154–158

    CAS  PubMed  Google Scholar 

  25. Taylor A, Sharma M, Tsirkas P, DiSpiezioSardo A, Setchell M, Magos A (2005) Reducing blood loss at open myomectomy using triple tourniquets: a randomized controlled trial. BJOG 112:340–345

    Article  CAS  PubMed  Google Scholar 

  26. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Syst Rev 2007: CD005355.

  27. Al-Shabibi N, Chapman L, Madari S, Papadimitriou A, Papalampros P, Magos A (2009) Prospective randomised trial comparing gonadotrophin-releasing hormone analogues with triple tourniquets at open myomectomy. BJOG 116(5):681–687

    Article  CAS  PubMed  Google Scholar 

  28. Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ (1993) The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study. Fertil Steril 60(6):956–962

    Article  CAS  PubMed  Google Scholar 

Download references

Authors’ contributions

El Sharkwy AI is responsible for the project development, data collection, and manuscript writing.

Lotfy M is responsible for the data collection and manuscript writing.

Abdeldayem MH is responsible for the data collection and manuscript writing.

Abdel Hameed A is responsible for the data collection and manuscript writing.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Ibrahim Abd Elgafor El Sharkwy, Mohamed Lotfy, Hussein Mohamed Abdeldayem & Ali Abdel Hameed

Authors
  1. Ibrahim Abd Elgafor El Sharkwy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed Lotfy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hussein Mohamed Abdeldayem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Abdel Hameed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ibrahim Abd Elgafor El Sharkwy.

Ethics declarations

The current randomized controlled trial was carried out at the Department of Obstetrics and Gynecology, Zagazig University Hospital, Zagazig, Egypt. Approval of the University Ethics Committee was gained.

A written consent was obtained from each women undergoing abdominal myomectomy.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Synopsis: Rectal misoprostol plus perivascular vasopressin was found to be more effective than pericervical tourniquet for decreasing blood loss during abdominal myomectomy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Sharkwy, I.A.E., Lotfy, M., Abdeldayem, H.M. et al. Rectal misoprostol plus perivascular vasopressin versus tourniquet to decrease blood loss during abdominal myomectomy. Gynecol Surg 13, 373–377 (2016). https://doi.org/10.1007/s10397-016-0956-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10397-016-0956-2

Keywords

Search

Navigation