Reducing Blood Loss at Abdominal Myomectomy with Preoperative Use of Dinoprostone: A Randomized Controlled Trial

Abstract

ABSTRACT Background: Abdominal myomectomy (AM) is the preferred alternative to hysterectomy for treatment of uterine myomas in women of reproductive age. The procedure is used to remove large intramural and subserosal myomas that are thought to impede conception and can restore fertility. However, the risk of recurrence for new myomas after AM is 50% after 5 years, with a 20% chance of subsequent surgery after 10 years. Furthermore, it has been determined that risk of morbidity (including blood loss) is higher after AM than after hysterectomy. AM can be a complicated surgery, with significant blood loss and operation times, potentially resulting in a conversion to hysterectomy. Aim of the Work: To determine the effect of administration of dinoprostone through different routes, vaginal and rectal prior to abdominal myomectomy on intra-operative blood loss. Patients and Methods: This study is a randomized controlled study, and was carried out in Ain Shams University Maternity Hospitals. The study was carried out in the period between October, 2014 and October 2016. The study included 150 patients who were divided randomly using computer program into three groups, each containing 50 patients. The first two groups were the study groups, and the third group was the control group. Results: The current study revealed no significant difference between studied groups regarding Blood loss. Conclusion: no statistical significance for the use of preoperative dinoprostone for reducing intraoperative blood loss during myomectomy, neither did its use have any effect on the secondary outcomes of the study including drop of haemoglobin, blood transfusion or hospital stay. Recommendations: Further studies are needed with larger population to ensure the efficacy of dinoprostone in this field.