The Use of Single Versus Double Dose of Intra-vaginal Prostaglandin E2

Ragab, Ahmed; Khaiary, Moustafa; Badawy, Ahmed

The Use of Single Versus Double Dose of Intra-vaginal Prostaglandin E2 "Misoprostol" prior to Abdominal Myomectomy: A Randomized Controlled Clinical Trial

Authors

Ahmed Ragab ¹

Moustafa Khaiary ²

Ahmed Badawy ²

¹ Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt; College of Medicine, Al-Jouf University, Al-Jouf, Saudi Arabia

² Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt

Abstract

Background: The study aimed to investigate the effectiveness of a single versus double dose of prostaglandin E2 "misoprostol, 400 microgram" prior to myomectomy for multiple uterine fibroids. Methods: This was a prospective randomized controlled trial comprised of 69 patients with multiple myomas undergoing myomectomy. Patients received either an intra-vaginal single dose of 400 microgram misoprostol 1 hr pre-operatively (group A, 34 cases) or 2 doses, 3 and 1 hr prior to surgery (group B, 35 cases). Operation time, intra and post-operative blood loss, hemoglobin concentration, blood pressure and body's temperature were estimated and compared in both groups. The data were statistically analyzed using chi-square test. The p<0.05 was considered significant. Results: In group B, the mean operative time was significantly (p<0.001) shorter than in group A (25.8±4.14 vs. 35.4±5.6 min respectively). The mean value for operative blood loss was significantly (p<0.001) smaller in group B (101.4±25.5 vs. 200.16±18.8 ml). There was a significant (p<0.01) rise of the body temperature in group B (38.5±0.7 vs. 37.18±0.84 C). There were no differences between the two groups regarding hemoglobin levels, post-operative febrile morbidity or length of hospital stay. Conclusion: In this study, two doses of pre-operative intra-vaginal misoprostol were more effective than one dose in reducing intra and post-operative blood loss and shortening of operation time during abdominal myomectomy.

Keywords

Abdominal myomectomy

Double dose

misoprostol

Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433-45.

Verkauf BS. Changing trends in treatment of leiomyomata uteri. Curr Opin Obstet Gynecol. 1993;5(3):301-10.

Garcia CR. Management of the symptomatic fibroid in women older than 40 years of age. Hysterectomy or myomectomy? Obstet Gynecol Clin North Am. 1993;20(2):337-48.

Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2001;(2):CD000547.

LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol. 1993;82(6):897-900.

Liu WM, Tzeng CR, Yi-Jen C, Wang PH. Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids. Fertil Steril. 2004;82(1):205-10.

Morita M, Asakawa Y, Uchiide I, Nakakuma M, Kubo H. Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma. Reprod Med Biol. 2004;3:33-7.

Ngeh N, Belli AM, Morgan R, Manyonda I. Pre-myomectomy uterine artery embolisation minimises operative blood loss. BJOG. 2004;111(10):1139-40.

Rossetti A, Paccosi M, Sizzi O, Zulli S, Mancuso S, Lanzone A. Dilute ornitin vasopressin and a myoma drill for laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1999;6(2):189-93.

Burkert H. Clinical overview of mesna. Cancer Treat Rev. 1983;10 Suppl A:175-81.

Kongnyuy EJ, van den Broek N, Wiysonge CS. A systematic review of randomized controlled trials to reduce hemorrhage during myomectomy for uterine fibroids. Int J Gynaecol Obstet. 2008;100(1):4-9.

Okin CR, Guido RS, Meyn LA, Ramanathan S. Vasopressin during abdominal hysterectomy: a randomized controlled trial. Obstet Gynecol. 2001;97(6):867-72.

Tulandi T, Beique F, Kimia M. Pulmonary edema: a complication of local injection of vasopressin at laparoscopy. Fertil Steril. 1996;66(3):478-80.

Zullo F, Palomba S, Corea D, Pellicano M, Russo T, Falbo A, et al. Bupivacaine plus epinephrine for laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol. 2004;104(2):243-9.

Fuchs AR, Fuchs F, Husslein P, Soloff MS. Oxytocin receptors in the human uterus during pregnancy and parturition. Am J Obstet Gynecol. 1984;150(6):734-41.

Farquhar C, Brown PM, Furness S. Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. BJOG. 2002;109(11):1273-80.

Wray S. Uterine contraction and physiological mechanisms of modulation. Am J Physiol. 1993;264(1 Pt 1):C1-18.

Baxter GS, Clayton JK, Coleman RA, Marshall K, Sangha R, Senior J. Characterization of the prostanoid receptors mediating constriction and relaxation of human isolated uterine artery. Br J Pharmacol. 1995;116(1):1692-6.

Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril. 2003;79(5):1207-10.