preoperative misoprostol vs. intraoperative peri-cervical hemostatic tourniquet to reduce blood loss in myomectomy

Background & objective: myomectomy remains the choice of treatment for women desiring uterine preservation while managing symptomatic leiomyomas. however, significant intraoperative blood loss during myomectomy poses major risks, including the need for blood transfusion and, in extreme cases, emergency hysterectomy. various techniques have been proposed to minimize blood loss, however, a clear consensus on the optimal method remains elusive. the present study was conducted with aim of comparing preoperative vaginal misoprostol versus intraoperative pericervical hemostatic tourniquets to reduce blood loss during myomectomymaterials & methods: this randomized clinical trial was conducted on 60 women undergoing elective abdominal myomectomy, divided into two groups: group a received vaginal misoprostol; group b had a peri-cervical foley catheter tourniquet. the outcomes assessed were intraoperative blood loss, operative time, hemoglobin/hematocrit changes, and postoperative complications.results: the tourniquet group demonstrated significantly lower estimated intraoperative blood loss compared to the misoprostol group (321.0±54.2 ml vs. 582.8±57.4 ml, p<0.001). postoperative hemoglobin and hematocrit levels were significantly higher in the tourniquet group, with a significantly smaller postoperative decline. the operative time was also significantly shorter in the tourniquet group (72.1±16.4 minutes vs. 80.6±12.6 minutes, p=0.027). blood transfusion rates, fever, hematoma formation, and bladder injury were lower in the tourniquet group, though differences were not statistically significant. no hysterectomies occurred; while adverse effects such as fever, nausea, and shivering were monitored in the misoprostol group, no significant or serious misoprostol-specific side effects were reported.conclusion: peri-cervical tourniquet application during myomectomy is more effective than vaginal misoprostol in reducing intraoperative blood loss and operative time.