Vaginal Misoprostol Versus Bilateral Uterine Artery Ligation in Decreasing Blood Loss in Trans-abdominal Myomectomy

Vaginal Misoprostol Versus Bilateral Uterine Artery Ligation in Decreasing Blood Loss in Trans-abdominal Myomectomy , a Randomized Control Trail

The study aims at comparison between the effect of preoperative misoprostol and bilateral uterine artery ligation regarding their effect to decrease blood loss in transabdominal myomectomy.

Inclusion Criteria:

• women in the reproductive age (20-40 years) diagnosed as having uterine fibroids who are consenting to have trans- abdominal myomectomy in the postmenstrual period diagnosed by: clinical symptoms and signs:
• abnormal uterine bleeding (menorrhagia or/and metrorrhagia)
• pain (dull aching lower abdominal pain or dysmenorrhea)
• pressure symptoms (dyspareunia, dysuria, dyschezia or /and backache)
• progressive abdominal enlargement (abdominal swelling) ultrasound (abdominal or transvaginal) to confirm the clinical diagnosis:
• maximum diameter of the largest fibroid is greater than 4 cm
• maximum number of uterine myomas is not to be more than 5 myomas
• uterine fibroid may be subserous or intramural

Exclusion Criteria:

• obesity (BMI >30 kg/m2)
• cardiac, endocrine, pulmonary or hematological disease (including anemia; hemoglobin level below 10 gm/dl)
• patients known to be allergic to prostaglandin preparations
• patients who received preoperative hormonal therapy (GnRH analogue)
• patients presented by or with suspected malignant gynecological disease patients diagnosed as having submucous uterine fibroids, cervical or supracervical fibroids, broad ligamentary fibroids and pedunculated fibroids patients with contraindication to general anaesthesia
• patients with positive pregnancy test
• virgin patients