Effect of a single preoperative dose of sublingual misoprostol on intraoperative blood loss during total abdominal hysterectomy.

OBJECTIVE To investigate whether use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH). METHODS In a randomized double-blind placebo-controlled trial at a tertiary care hospital in Kolkata, India, between March 2011 and April 2012, women (n=132) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery. The primary outcome measure was intraoperative blood loss was. The secondary outcomes were postoperative drop in hemoglobin, need for blood transfusion, and incidence of adverse effects. RESULTS The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (356 mL vs 435 mL; P=0.049). The mean postoperative hemoglobin concentration was higher (10.5 g/dL vs 9.5 g/dL; P<0.001) and the postoperative drop in hemoglobin was smaller (1.1g/dL vs 1.9 g/dL; P=0.004) in the misoprostol group than in the placebo group. No significant adverse effects occurred in either group. CONCLUSION The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects. Clinical Trial Registry India (www.ctri.nic.in): CTRI/2011/091/000216.