The effect of combined vaginal misoprostol and tourniquet or tourniquet alone on reducing blood loss during abdominal myomectomy: a randomised controlled trial

Background: Uterine fibroids are common benign tumours in women, with myomectomy being a primary surgical treatment for those desiring to preserve fertility. This procedure is often associated with significant haemorrhage. Both the tourniquet and misoprostol are effective at reducing the associated blood loss, and their combined use may enhance this effect. Objective: The study aimed to compare blood loss reduction using vaginal misoprostol plus a tourniquet versus a tourniquet alone during abdominal myomectomy. Methods: This study was an open-label randomised controlled investigation involving 80 women with symptomatic fibroids, divided into two groups: the treatment group (misoprostol plus tourniquet) and the control group (tourniquet alone). The primary outcome measured was intraoperative blood loss through changes in haemoglobin levels. Secondary outcomes included the need for blood transfusion, postoperative febrile morbidity, surgery duration, misoprostol’s adverse effects, and length of hospital stay. The treatment group received a single 600µg dose of vaginal misoprostol one hour before surgery. Data analysis utilised SPSS version 22, employing t-tests for continuous variables and Chi-squared tests for categorical variables, with a significance threshold of p < 0.05. Results: Results indicated a significant reduction in blood loss (haemoglobin change) when misoprostol plus tourniquet was used for uterine sizes ≥ 18 weeks (1.40 ± 0.50 vs 1.89 ± 0.80 g/dl, p = 0.005). However, there were no significant differences in blood transfusion need (2.5% vs 5.0%, p = 0.55), febrile morbidity (2.5% vs 2.5%, p = 0.99), surgery duration (102.73 ± 36.02 vs 104.08 ± 40.04 min, p = 0.874), or hospital stay length (2.88 ± 0.607 vs 3.05 ± 0.714 days, p = 0.241). Misoprostol adverse effects were minimal (10% in the treatment group). Conclusion: A 600µg vaginal misoprostol dose plus a tourniquet significantly reduces blood loss during abdominal myomectomy for uterine sizes ≥ 18 weeks compared to a tourniquet alone, with similar transfusion requirements, surgery duration, febrile morbidity, and hospital stay lengths.