Title

EFFECTIVENESS OF TOURNIQUET WITH AND WITHOUT ADJUNCTIVE MISOPROSTOL ON HAEMORRHAGE DURING MYOMECTOMY

Background

Minimising intraoperative haemorrhage is crucial during open abdominal myomectomy, as excessive bleeding remains the most dreaded complication of this prevalent gynaecological procedure. Although a tourniquet is an effective haemostatic method, there is limited evidence regarding the effectiveness of combining a tourniquet with misoprostol

Objective

The primary aim of this study was to compare the effects of combining misoprostol with a tourniquet against using a tourniquet alone on intraoperative blood loss

Methodology

This triple-blind, two-centre randomised controlled trial took place in two tertiary hospitals in Delta State from July 1, 2020, to January 31, 2021. A total of 140 consenting women undergoing open myomectomy were randomly assigned to either the intervention group (tourniquet and misoprostol) or the control group (tourniquet only). The primary outcome measured was intra-operative blood loss, while the secondary outcome assessed was the duration of surgery. Data analysis was performed using SPSS (version 21), employing Chi-square tests for categorical variables and Student’s t-tests for continuous variables. Results are displayed in text, tables, and figures, with statistical significance established at P<0.05

Results

Therewasnostatisticallysignificantdifferenceinthebaseline characteristicsbetweenthetwoarms.Therewasastatistically significantdifferenceinintraoperativebloodlossintheinterve ntion arm (678.17±42.38mL) and the control (837.03 ± 39.17mL) (P-value=0.042).The mean duration of surgery was 104.33± 7.21mins for the intervention arm and 112.53 ± 7.27mins for the control arm, similar in both groups (P-value =0.09).

Discussion and Conclusion This study demonstrated a statistically significant reduction in intraoperative blood loss with the combined use of vaginal misoprostol and a pericervical tourniquet compared to the tourniquet alone (678.17±42.38ml vs. 837.03±39.17ml; P=0.042), leading to the rejection of the null hypothesis. Similar reductions were reported by Nnagbo et al.¹ and Agyabeng et al.². However, there was no additional benefit in operative time with the combination therapy.

Reference 

1.Nnagbo JE, Dim CC, Eze MI, Mba SG. Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria. Niger J Clin Pract. 2023;26(4):454–462.

2.Alhalaby AEF, Shehl HA, Abo Shady HM, El Khouly NI. Effect of use of single dose of misoprostol on blood loss during myomectomy. Egypt J Hosp Med. 2021;82(2):296–301.

3.Nwobodo EI, Okafor II, Ezechi OC, et al. Effects of misoprostol in reducing blood loss during abdominal myomectomy in Nigeria. Niger J Clin Pract. 2023;26(4):592–598

4. Adesina KT, Owolabi BO, Raji HO, Olarinoye AO. Abdominal myomectomy: A retrospective review of determinants and outcomes of complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Malawi Med J. 2017;29(1):37–42.

5. Ezechi OC, Nwobodo EI, Okafor II, et al. Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial. J Obstet Gynaecol Res. 2019;45(3):640–646