Pharmacie française en ligne: Acheter des antibiotiques sans ordonnance en ligne prix bas et Livraison rapide.
J. Med. Sci. (Peshawar, Print) October 2013, Vol. 21, No. 4: 171-173
PRE-OPERATIVE USE OF MISOPROSTOL IN MAJOR
Jamila Mehnaz Naib, Parveen Naveed, Sitwat Fatima
Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar - Pakistan
To study the effect of preoperative use of misoprostol on reducing blood loss in Major gynaecological
Material and Methods:
This was a hospital based interventional study conducted in the department of Obstetrics
and Gynaecology, Khyber Teaching Hospital, Peshawar, Pakistan from March 2010 to November 2012. A total of 100
cases were studied in this comparative trial. Randomly selected 50 patients had preoperative per rectal insertion of
tablet misoprostol 400 micrograms 20 minutes prior to surgery and were compared to 50 other patients in whom no
misoprostol was used before or during surgery. All of these were elective gynaecological surgeries including
hysterectomies and myomectomies etc. Data was analyzed using SPSS.
A total of 100 cases were studied, in 50 patients, preoperative insertion of misoprostol 400 micrograms was
carried out and 50 cases without its use were studied for comparison. Main outcome measures were approximate
per-operative blood loss, need for transfusion and post op Hb (gm/dl). In the first group without misoprostol mean
blood loss was 370ml + 170.233 SD and mean post-op Hb was 10.34 + 0.4102 SD. In the group with misprostol the
mean blood loss was 310cc + 197.284 SD and mean postoperative Hb was 10.761 + 0.4998 SD. Six percetn of
misoprostol group and 28% of no misoprostol needed transfusion.
More studies are needed to establish the benefits of preoperative misoprostol before routine use of this
drug is recommended.
Misoprostol, Preoperative, Blood Loss, Transfusion.
apparently reduces to uterine blood flow, increases
Misoprostol, a prostaglandin E1 analogue has
Myometral contractions in uterine atonic postpartum
been widely used in clinical practice of Obstetrics &
Gynaecology. It stimulates uterine contractions and this
Caesarean section and myomectomy.1,2 Use of
increase in myometrial contractions will lead to
misoprostol appeared to be beneficial in reducing
contraction of the vessels supplying the uterus and
blood loss during Laproscopic Assisted Vaginal
leiomyoma1. Abdominal hysterectomies are performed
Hystrectomy (LAVH) for large uterine Myomas.
for various indications like polymenorrhagia,endometrial Hyperplasia, menorrhagia and fibroid
uterus. Uterine leiomyoma is the commonest benign
This was a hospital based interventional study.
tumour affecting women in reproductive age around
The study was conducted in the department of Obst &
20-50% can cause symptoms that warrant treatment.
Gynae, Khyber Teaching Hospital from March 2010 to
Different medical therapies like Gonadotrophin
November 2012. A total of 100 cases were studied in
Releasing Hormone (GnRH) analogues, mifepristone,
this comparative trial. Randomly selected 50 patients
progestins and androgens have been tried. Total
had preoperative use of tablet misoprostol 400 mcg (2
abdominal hysterectomy is the definitive treatment.
tablets) 20 minutes prior to start of surgery and these
Significant operative blood loss that required blood
were compared to 50 other patients in whom no
transfusion is not uncommonly encountered after Trans
misoprostol was used before or during surgery. Out of
these 50 cases in each group 25 were abdominalhysterectomies and 25 were myomectomies. Blood
loss was measured by reading the level in suction bottle
& using a standard 500 c.c kidney tray for blood and
clots. The inclusion criteria was Symptomatic woman
Khyber Teaching Hospital, Peshawar - PakistanCell: +92-300-5937571
undergoing total abdominal hysterectomy and
myomectomy due to various Benign gynaecological
J. Med. Sci. (Peshawar, Print) October 2013, Vol. 21, No. 4
study the mean blood loss for cases without
contraindication to misoprostol, mitral stenosis, severe
misoprostol was 370ml and mean postoperative Hb
asthma, severe hypertension,known Allergy to
was 10.34 gm/dl. Mean blood loss for group with
prostaglandin or a known history of pelvic or ovarian
misoprostol was 310cc (with S.D 197.284) and mean
endometriosis. Pre-operative investigations including
postoperative Hb was 10.76 gm/dl. Study by Celik et
Hb gm%, urine R/E, random blood sugar, clotting
al has shown that preoperative misoprostol reduces
profile, HBS Ag, HCV screen, X-Ray chest, ECG.
intraoperative blood loss and need for blood
Post-operative Hb was done on second postoperative
transfusion1. This use of misoprostol as an effective
day(after 48 hrs –for all patients). Blood transfusion
method to decrease blood loss during myomectomy
during surgery was recorded on proforma. Data was
is also noted in the Cochrane database5. In our study
administration of misoprostol was done by rectal route.
This administration by rectal route may allow the drug
to be absorbed without and may avoid any adverse
A total of 100 cases were studied. In 50 patients,
effect of oral route and has a longer half-life than oral
preoperative per rectal insertion of misoprostol 400
mcg was carried out and 50 cases without its use were
In our study 28% of patients in group without
studied for comparison. The main outcome measures
misoprostol needed transfusion compared to 6% in
were approximate per operative blood loss, need for
group where misoprostol was used. Comparable
transfusion during surgery and post op Hb (gm/dl). In
results are shown by Cheinarong et al8, Chaij et al9
the first group without misoprostol mean blood loss
and kalogiamedes10 where there was decreased blood
was 370ml + 170.233 SD mean post-op Hb was 10.34
loss and hence lesser transfusions. Other studies of
+ 0.4102 SD. In the group with misprostol the mean
American surveillance of hysterectomies11 and Carter
blood loss was 310cc + 197.284 SD and mean
JE12 show varying results. Also Ishrat S et al from Dhaka
postoperative Hb was 10.761 + 0.4998 SD. Six
also state that single preoperative dose of misoprostol
percent of misoprostol group and 28% of no
is a reliable method for reducing intra operative blood
loss and need for transfusion13. Becherd DE14 and Gold
berg et al15 have used of misoprostol in gynaecological
patients in the group with use of misoprostol did not
operations and found it useful like in our results.
need any Transfusion, where as 3 (6%) patients needed
transfusion in the other group. In the group where nomisoprostol was used 36 (72%) patients needed no
transfusion and 14 (28%) patients needed transfusion.
benefits of misoprostol when used in Myomectomy or
hysterectomy procedures before routine use of this
myomectomies & 5 were hysterectomies. Out of these
14, 11 needed 1 pint of blood and 3 needed 2
transfusions so in the patients needing transfusion 6%of misoprostol group and 28% of the group with no
We found misoprostol to be an easy and cost
misoprostol needed transfusion. P value = 0.0893. By
effective agent to be used but our results were
conventional criteria the difference is considered to be
evaluated through SPSS version 10 and P value was
not quite significant. Statistically so we believe that
0.0893. By conventional criteria the differences in our
larger multi centered studies should be conducted.
study between the two groups was considered to benot quite significant statistically, so we believe that
larger multicenter trials should be conducted.
Heavy menstrual flow and anaemia are common
symptoms of patients with myomatous uterus or inDysfunctional Uterine Bleeding (DUB). Reducing the
Celik H, Sapnaz E, use of a single preoperative dose
misoprostol is efficacious for patients who undergo
blood loss during surgery decreases the need for blood
abdominal myomectomy, Fertile sterile 2003 79 (5):
transfusion and decreases postoperative morbidity.
The major effect of misoprostol is on the myometriumand the cervix. Increased uterine contractility directly
Acharya G, Al-Samunarai MT, Patel N, Al-Harik A,
affects uterine vasculature that stems from both
Kiservd T. A randomized controlled trial comparing
uterine artery and utero-ovarian anastomosis,
effect of oral misoprostol and intravenous
syntocinon on intra operative blood loss during
decreasing blood supply to the uterus and myomas3.
caesarean section. Actaobstet and gynaecol 1999;
constricted uterine vasculature due to uterine
contraction and vasoconstricive effect of misoprostol
Chi-huangcheu, Gwo-Bug wu, JahYaoliu. Effect of
results in reducing intra operative blood loss4. In our
utero tonics on intra operative blood loss during
J. Med. Sci. (Peshawar, Print) October 2013, Vol. 21, No. 4
lapro-scopy assisted vaginal delivery-randomize
J. Obstet Gynaecol Reprod Biol. 2011 158(1):
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Baxter GS, Clayton JK, Coleman RA, Marshalek,
Kalogiannidis 1, Xizomeritis P, Prapas N, Prapas Y.
Sangha R, Senior J. Characterization of the
Intra vaginal misoprostol reduces intra operative
prostanoidreceptors mediating constriction and
blood loss in minimally invasive myomectomy: a
relaxation of human isolated uterine artery. Br J
randomized clinical trial. Clin Exp. Obstet Gynaecol
Kongnyuy EJ, Wiysonge CS. Intervention to reduce
Lepine LA, Hills SD, March Banks PA, et al.
hemmorrhage during myomectomy for fibroids.
Hysterectomy surveillance United States. CDC
Cochrane Data base Sys Rev. 2009. CD005355.
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Khan RU, El Rafacy H. Pharnacokikenitics and
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Carter JE, Ryoo J, Katz A. Laproscopic assisted
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study with total abdominal hysterectomy. JAM
Associate gynaecology laproscopic 1994; 1;
Zieman M, Fong SK, Benowitz NL, Bankster D,
Darney PD. Absorption kinetics of misoprostol with
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Ishrat S, Islam F. Misoprostol in obstetrics and
gynaecology – a clinical review J Dhaka Med Coll.
Choksuchat C. Clinical use of misoprostol in
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Bechard DE, Spirlet M. Use of misoprostol in
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gynaecology and obstetrics. Gynecol Obstet Fetal
Chai J, How E, LI CF, Pun TC, Young SB, HOPC. A
Goldberg AB, Carusi DA, Meckstroth KR.
pilot study of pre-operative misoprostol in
Misoprostol in gynaecology Currwomens Health
reducing operative loss during hysterectomy. Eur
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