Effect of a Single Preoperative Dose of Sublingual Misoprostol on Intraoperative Blood Loss During Abdominal Hysterectomy Due to Fibroid Uterus

Abstract

Background: Uterine fibroids are a common cause of abnormal uterine bleeding and may necessitate abdominal hysterectomy when symptomatic. Intraoperative blood loss remains a significant concern during such procedures. Pharmacologic interventions are routinely used to minimize blood loss, but alternative agents like misoprostol have also shown promise due to their uterotonic effects. Aim: To evaluate the effectiveness of a single preoperative dose of sublingual misoprostol in reducing intraoperative blood loss during abdominal hysterectomy for fibroid uterus, in comparison with conventional intravenous tranexamic acid. Methodology: A randomized controlled trial was conducted at the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore, from October 2024 to March 2025. Seventy women aged 35–55 years undergoing abdominal hysterectomy for symptomatic fibroid uterus were randomly assigned to two groups. Group A received 400 µg of sublingual misoprostol, while Group B received 1 g of intravenous tranexamic acid, both administered one hour before surgery. Intraoperative blood loss was objectively measured using suction and gauze weight methods. Postoperative hemoglobin drop, need for transfusion, hospital stay, and adverse effects were also assessed. Data were analyzed using SPSS v22.0, with p ≤ 0.05 considered statistically significant. Results: The mean intraoperative blood loss was significantly lower in the misoprostol group (342.7 ± 289.1 mL) compared to the tranexamic acid group (417.6 ± 265.3 mL; p = 0.041). The postoperative hemoglobin level was higher (10.6 ± 1.1 vs. 9.7 ± 1.3 g/dL; p < 0.001), and the hemoglobin drop was significantly less in the misoprostol group (1.0 ± 0.9 vs. 1.7 ± 1.1 g/dL; p = 0.008). Although fewer patients required blood transfusion in the misoprostol group (5.7% vs. 11.4%), the difference was not statistically significant (p = 0.40). Adverse effects were mild and similar across both groups. Conclusion: A single sublingual dose of 400 µg misoprostol administered preoperatively is more effective than intravenous tranexamic acid in reducing intraoperative blood loss during abdominal hysterectomy for fibroid uterus. It is well tolerated and can be considered a viable alternative for blood loss management in such surgeries.