Intravenous Tranexamic Acid Versus Pericervical Tourniquet To Decrease Blood Loss In Trans-Abdominal Myomectomy

this study aims at comparing between different methods to decrease blood loss in trans-abdominal myomectomy. this study compares between medical (intravenous tranexamic acid administration) and non medical (pericervical tourniquet) methods in decreasing blood loss intra operative

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).

All women with clinical presentation suggestive of uterine fibroid will undergo abdominal and trans-vaginal ultrasound to confirm the clinical diagnosis and to exclude patients with:

• Submucous uterine myomas.
• Cervical or supracervical myomas.
• Broad ligamentary and pedunculated myomas.
• Associated pelvic pathology.

Ultrasound criteria of uterine fibroids of included patients:

• Maximum diameter of the largest fibroid is greater than 4cm.
• Maximum number of uterine myomas is not to be more than 5 myomas.
• Uterine fibroid may be subserous or intramural.

Exclusion Criteria:

• Obesity (body mass index >30 kg/m2).
• Cardiac, endocrine, pulmonary or hematological disease (including anemia; hemoglobin level below 10gm/dl).
• Patients known to be allergic to tranexamic acid.
• Patients who received pre-operative hormonal therapy (such as a 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.