الفهرس 
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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. 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 . Hemorrhage requiring blood transfusion is one of the most frequently cited complications of total abdominal hysterectomy, occurring in 2%–12% of cases Various methods had been adopted to decrease blood loss during TAH. Preoperative administration of gonadotropin-releasing hormone (GnRH) analogs have been found to be effective in reducing the size and vascularity of large myomas; however, significant adverse effects like hot flushes and osteoporosis have been reported after its use. Although injection of vasopressin in the lower uterine segment was found to be beneficial in reducing blood loss during abdominal hysterectomy, serious complications such as hypotension, myocardial infarction, and cuff cellulitis have been reported after use of this drug. Misoprostol, a synthetic analogue of prostaglandin E1, has been extensively evaluated as an uterotonic agent in obstetrics mainly for prevention and management of postpartum hemorrhage and reduction of bleeding during cesarean delivery. The misoprostol tablet is very soluble and can be dissolved in 20 minutes when it is put under the tongue. The peak concentration is achieved about 30 minutes after sublingual administration, a sublingual dose achieves a higher peak concentration than that of oral and vaginal administration. This is due to rapid absorption through the sublingual mucosa as well as the avoidance of the first-pass metabolism via the liver .Strong myometrial contractions induced by misoprostol indirectly cause relative a vascularity in the myoma and may also contribute to a reduction in bleeding. In addition, a decrease in uterine artery blood flow in myoma has been observed by Doppler velocimetry after misoprostol administration. The aim of the present study is to asses the effect of pre oprative administration of misoprostol in women undergoing hysterectomy as regard blood loss. Patients and Method: A total of 70 women were included in the study. They were randomly allocated in two groups • Study group : (misoprostol G): Patients undergoing total abdominal hysterectomy and received two tablets of Misoprostol400 μg(one tablet=200 μg )30 minutes before operation (35 patients). • Control group : (placebo G): Patients undergoing total abdominal hysterectomy and received two tablets of Placebo 30 minutes before operation(35 patients). The patients in both groups were selected and matched according to the following: • Inclusion criteria: 1- Age ranging between 35-55 years. 2- BMI (20-30) kg/m2. 3- Patients with abnormal uterine bleeding complaining from one or more of the following: Fibroid, Endometriosis, Adenomyosis, Dysfunctional uterine bleeding, and Pelvic inflammatory disease. • Exclusion criteria: 1. Women with heart disease, severe hypertension, hematologic disorders, glaucoma, bronchial asthma, liver disease. 2. Women with adnexal mass. 3. Women who had undergone previous myomectomy. 4. Women who received GnRH analogs. 5. Women who received anticoagulant drugs 6. Women allergic to prostaglandins. 7. Past history of Malignancy & extensive adhesions. The following was done for all patients included in the study: - Detailed history taking. - Abdominal and pelvic examination. - 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. - Measure blood loss using ( a gravimetric method)was used. The total duration of surgery from skin incision to skin closure was calculated. - HB level was talken 24 hrs after the operation. - The primary outcome measure was introperative blood loss. - The secondary outcomes was postoperative DROP in hemoglobin, need for blood transfusion, and incidence of adverse effects. Side effects of misoprostol including abdominal pain, nausea, vomiting and diarrhea were recorded 30 minutes after administration of the drug. Results: In our study no significant difference between the studied groups regarding preoperative hemoglobin and hematocrit. Postoperative hemoglobin and hematocrit were significantly higher among misoprostol group than among placebo group. Hemoglobin reduction and Hematocrit reduction were significantly lower among misoprostol group than among placebo group. Blood loss was significantly lower among misoprostol group than among placebo group. Operation time was insignificantly lower among misoprostol group than among placebo group. Blood transfusion was non-significantly less frequent among misoprostol group, while nausea & vomiting, diarrhea, headach,fever and shievering were non-significantly more frequent among misoprostol group. The most common indication for hysterectomy were fibroid ,dysfunction uterine bleeding and , adenomyosis.fibroid was the most significance for the effect of misoprostol in decrease blood loss ,heamoglobin and heamatocrit during abdominal hysterectomy more than adenomyosis and dysfunction uterine bleeding.