EFFICACY OF VAGINAL MISOPROSTOL VERSUS INTRAVENOUS CARBETOCIN IN DECREASING BLOOD LOSS IN ABDOMINAL MYOMECTOMY: A RANDOMIZED CONTROLLED TRIAL
Dalia Farouk, Ahmed M Ibrahim
Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Objective: to assess the efficacy of administration of vaginal misoprostol compared to carbetocin in decreasing blood loss in women undergoing abdominal myomectomy. Study Design: A prospective randomized controlled clinical trial. Patients and Methods: We conducted the study in obstetrics and gynecology hospital, faculty of medicine, Cairo University, Egypt from February 2016 till November 2016. we included 88 women with symptomatic leiomyomas and candidates for abdominal myomectomy. We randomly allocated patients into one of two groups: group A who received 200 mcg vaginal misoprostol one hour preoperatively and group B in whom a bolus of 100 micrograms carbetocin was given slowly intravenous with the induction of anesthesia. The primary outcome was estimated intra-operative blood loss while the secondary outcomes were the need for blood transfusion, postoperative hemoglobin and hematocrit, operative time, length of hospital stay, and postoperative fever. Results: women’s baseline characteristics were comparable between the two groups with no statistically significant differences between them. The amount of intraoperative blood loss was lower in the misoprostol group than carbetocin group, however, this difference was not statistically significant (677.4±240.8 in misoprostol group 700.0±189.7 in carbetocin group; p value=0.72). Postoperative hemoglobin and hematocrit were comparable between the misoprostol group (10.74±1.28 & 33.42±4.12 respectively) than carbetocin group (10.62±1.32 & 33.20±4.83 respectively). Other outcomes as hospital stay, operative time, postoperative nausea and vomiting did not also show statistically significant differences in both groups. Conclusion: vaginal misoprostol has comparable efficacy to intravenous carbetocin in reducing blood loss during abdominal myomectomy and the need for blood transfusion. Both drugs are safe with similar side effect profiles.