Oxytocin Infusion Versus Preoperative Rectal Misoprostol: A Comparison of Blood Loss in Myomectomy Patients

Abstract

Background: Abdominal myomectomy is commonly performed for symptomatic uterine fibroids but is often associated with significant intraoperative blood loss. Pharmacologic agents such as oxytocin and misoprostol are used to reduce bleeding; however, comparative evidence, particularly for rectal misoprostol, remains limited. Objective: To compare oxytocin infusion with preoperative rectal misoprostol for reduction of intraoperative blood loss in women undergoing abdominal myomectomy. Study Design: Quasi-experimental study. Settings: Department of Obstetrics and Gynecology, Lahore General Hospital, Lahore Pakistan. Duration: March 2023 to September 2023. Methods: One hundred and ten women undergoing elective abdominal myomectomy were enrolled and assigned alternately into two groups of 55 each. Group A received intraoperative oxytocin infusion and Group B received 400 µg rectal misoprostol 30 minutes before incision. The primary outcome was intraoperative blood loss. Secondary outcomes included perioperative hemoglobin indices, blood transfusion requirement, duration of surgery, postoperative fever, hospital stay, and drug-related adverse effects. Data were analyzed in SPSS 26 using independent-samples t test and chi-square/Fisher’s exact test. Results: Baseline demographic, fibroid-related, and operative characteristics were comparable between groups. Mean intraoperative blood loss was significantly lower with rectal misoprostol than with oxytocin infusion (395.29 ± 63.95 mL vs 432.69 ± 69.64 mL; p=0.004). Preoperative hemoglobin, postoperative hemoglobin, and hemoglobin drop were not significantly different. No patient required blood transfusion. Postoperative fever and hospital stay were similar. Shivering, nausea/vomiting, and diarrhea were significantly more frequent with misoprostol, whereas hypotension and tachycardia were numerically more common with oxytocin. Conclusion: Preoperative rectal misoprostol was more effective than oxytocin infusion in reducing blood loss during abdominal myomectomy, but it was associated with more prostaglandin-related adverse effects.