Single-Dose Preoperative Vaginal Misoprostol for Reducing Blood Loss During Abdominal Hysterectomy: A Randomized Study

Objective: Average operative blood loss in abdominal hysterectomy—the most common gynecologic surgery—ranges 300–400 mL. This may not be much in normal women, but women with preexisting anemia may require blood products pre- or postoperatively or have poor healing and more surgical-site infections. Minimizing blood loss in abdominal hysterectomy for leiomyomatosis uteri has been studied with limited success of gonadotropin-releasing hormone analogues and misoprostol. This study assessed the effectiveness of a single vaginal preoperative dose of misoprostol prior to open abdominal hysterectomy for reducing blood loss and drop of postoperative hemoglobin, compared to routine hysterectomy without misoprostol. Materials and Methods: This was a randomized, parallel-group, placebo-controlled interventional-drug trial with double-blinding. Each of 2 groups had 35 participants. Women randomized to group A received 2 200-μm tablets of misoprostol vaginally 30 minutes before the start of the operation. Women randomized to group B received 2 placebo tablets. Results: Both groups had comparable mean ages, body mass indices (BMIs), uterine sizes, symptoms, and medical comorbidities. The mean uterine weight in both groups was >365–391g and mean operating times (111–119 minutes) were similar in both groups. Operative blood loss was 394 ± 186 mL in the misoprostol group and 455 ± 288 mL in the placebo group, which was not significant. (p = 0.228). A difference of 61.5 mL (difference of 13%) occurred between the groups, but did not significantly affect postoperative requirements for blood products, postoperative complications, or hospital stays, which were not statistically different in the groups. Conclusions: Using a single vaginal misoprostol dose prior to total abdominal hysterectomy for large-size uteri (>12 cm) does not significantly reduce the intraoperative blood loss, drop in hemoglobin, nor need for postoperative blood transfusion.