الفهرس 
Polycystic Ovary Syndrome (PCOS)Only 14 pages are availabe for public view
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Abstract
Hysterectomy is the surgical removal of the uterus. It is the most frequently performed major gynaecological surgical procedure, with millions of procedures performed annually throughout the world (DeLancey et al., 2013).
Hysterectomy can be performed for benign and malignant indications. Approximately 90% of hysterectomies are performed for benign conditions, such as fibroids causing abnormal uterine bleeding; other indications include endometriosis/adenomyosis, dysmenorrhoea, dyspareunia and prolapsed (Panda et al., 2015).
Hemorrhage is a feared complication for any surgeon. Intraoperative hemorrhage occurs in 1% to 2% of hysterectomies, intraoperative hemorrhage is defined as blood loss >1L or any blood loss that requires a blood transfusion (Parker and Wagner, 2010).
Misoprostol (15-deoxy-16-hydroxy-16-methyl PGE1) is a synthetic prostaglandin E1 analogue was developed for gastric ulcer prevention but commonly used in reproductive health because of its uterotonic and cervical priming action (Laura et al., 2016).
The misoprostol tablet is very soluble and can be dissolved in 20 minutes when it is put under the tongue. Sublingual misoprostol has the shortest time to peak concentration, the highest peak concentration and the greatest bioavailability when compared to other routes (Tang et al., 2007).
This study aimed to investigate whether preoperative administration of sublingual misoprostol is beneficial in reducing intraoperative blood loss among women undergoing total abdominal hysterectomy.
This study was carried on one hundred and eighteen patients, they were randomly allocated in two groups:
- group A: Included 59 patients undergone total abdominal hysterectomy and received 400 μg of sublingual Misoprostol 30 minutes before operation.
- group B: Included 59 patients undergone total abdominal hysterectomy and received Placebo 30 minutes before operation.
All of them were subjected to:
- Detailed history taking.
- Abdominal and pelvic examination.
- Baseline demographic data comprising age, parity, body mass index (calculated as weight in kilograms divided by the square of height in meters), and size of uterus was recorded.
- Preoperative HB level recorded.
- Patients undergone TAH with or without bilateral salpingo-oophorectomy.
- A gravimetric method was used to measure blood loss. The total volume of blood loss (M) during operation was measured by adding the volume of contents of the suction container (a) to the difference in weight (where 1.06 g is equivalent to 1 mL) between the dry (b)and wet (c) mops used during operation:
M = a + (c − b) (Fiala et al., 2007).
- The total duration of surgery from skin incision to skin closure will be noted.
- Another HB level was talken 24 hrs after the operation.
- Side effects of misoprostol including abdominal pain, nausea, vomiting, diarrhea and were recorded 2 hours after administration of the drug, immediately preoperative and also postoperative.
The results of this study showed there were no significant difference between the studied groups regarding demographic characteristics (Age, BMI, Parity).
The results of this study showed that there was a significant reduction of blood loss during TAH after sublingual administration of 400 μg of misoprostol 30 minutes before surgery compared with placebo (355.1 mL vs 531.4 mL; P < 0.001).
The mean postoperative hemoglobin concentration was higher (11.1g/dL vs 10.7 g/dL; P < 0.015) and the postoperative DROP of hemoglobin was smaller (1.2 g/dL vs 1.8 g/dL; P < 0.001) in the misoprostol group.