Keywords
Misoprostol
Tranexamic acid
Blood loss
Hemoglobin decline
Blood transfusion
How to Cite
Abstract
Background: Excessive intraoperative blood loss is a major challenge during myomectomy, often leading to hemodynamic instability and increased transfusion requirements.
Objective: To compare the efficacy of misoprostol versus tranexamic acid in reducing intraoperative blood loss during abdominal myomectomy.
Methods: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Allied Hospital II, Faisalabad, from February 2025 to May 2025. A total of 200 women aged 30–50 years undergoing abdominal myomectomy were randomized into two groups of 100 each. Group A received 400 µg of vaginal misoprostol one hour preoperatively, while Group B received tranexamic acid 15 mg/kg (maximum 1 g) intravenously 20 minutes before skin incision.
Results: Baseline characteristics were comparable between the two groups. Mean intraoperative blood loss was significantly lower in the misoprostol group (298.5 ± 75.2 ml) compared to the tranexamic acid group (356.2 ± 88.9 ml, p < 0.001). The mean fall in hemoglobin was also less in the misoprostol group (0.7 ± 0.3 g/dl) than in the tranexamic acid group (1.2 ± 0.4 g/dl, p < 0.001). Blood transfusion was required in 7% of patients in the misoprostol group versus 16% in the tranexamic acid group (p = 0.04). Operative time was not significantly different between groups (84.5 ± 12.3 vs. 87.1 ± 13.0 minutes, p = 0.18).
Conclusion: It is concluded that misoprostol is more effective than tranexamic acid in reducing intraoperative blood loss, minimizing hemoglobin decline, and decreasing transfusion requirements during myomectomy, without increasing operative time.