The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

The Effect of Sublingual Misoprostol on Bleeding During Abdominal Myomectomy Surgery: A Clinical Trial Study

Document Type : Original Article

Authors
Zahra Lesani 1
Zeinab ShakerArdekani 2
Somayyeh Noei Teymoordash 3
Somayeh Moradpanah 4
1 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2 Specialist in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department Obstetrics and Gynecology, Firoozgar Clinical Research and Development Center (FCRDC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
4 Assistant Professor, Department Obstetrics and Gynecology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
10.22038/ijogi.2026.91233.6554
Abstract
Introduction: Misoprostol, a prostaglandin E1 analog, has been proposed to reduce uterine bleeding due to its contractile effects on the uterine myometrium. The present study was conducted with aim to investigate the effect of sublingual administration of misoprostol in reducing bleeding during abdominal myomectomy.
Methods: This triple-blind, randomized clinical trial study was conducted in 2024-2025 on 96 women aged 20 to 39 years who were candidates for abdominal myomectomy at Shariati Hospital, Tehran. Participants were randomly divided into two equal groups receiving 400 micrograms of sublingual misoprostol or placebo, which was administered 1 hour before the skin incision. The volume of intraoperative bleeding was estimated by collecting blood in the suction and calculating the amount of blood absorbed in the gauze and pads. The decrease in hemoglobin, the need for blood transfusion, and drug side effects were also recorded. Data were analyzed using SPSS (version 22) and independent t-test, analysis of covariance (ANCOVA), and chi-square test. P<0.05 was considered significant.
Results: The results showed that the mean bleeding volume in the intervention group was 144 ml less than the control group (345 ± 128 vs. 489 ± 167 ml; p<0.001). The decrease in Hb and Hct in the intervention group at 24 hours after surgery was 1.2 ± 0.6 g/dL and 3.5 ± 1.1, respectively, which was significantly different from the control group (2.1 ± 0.8 g/dL and 5.8 ± 1.6) (p<0.001). The duration of surgery in the intervention group was 13 minutes shorter (p=0.015) and the length of stay in the hospital was 0.7 days shorter (p=0.003). The need for blood transfusion was significantly reduced in the intervention group (4.2% vs. 18.8%; p=0.021). However, the incidence of some adverse complications such as nausea (25% vs. 10.4%) and chills (16.7% vs. 4.2%) was higher in the intervention group (p<0.05).
Conclusion: According to the results obtained, misoprostol can be used as an effective and safe adjunctive method in the management of bleeding during abdominal myomectomy.
Keywords
Abdominal Myomectomy
Blood Transfusion
Hemoglobin Drop
Intraoperative Bleeding
Sublingual Misoprostol
Uterine Fibroid
Subjects
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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 4
June 2026
Pages 31-41