Effect of uterotonics on intra-operative blood loss during laparoscopy-assisted vaginal hysterectomy: A randomised controlled trial

Objective: To investigate the effectiveness of uterotonics misoprostol and oxytocin on reducing blood loss during laparoscopy-assisted vaginal hysterectomy (LAVH). Design: Randomised, double-blind placebo-controlled trial. Setting: University hospital. Population: One hundred and seventy-three women underwent LAVH for symptomatic uterine myomas and were randomly allocated to uterotonics (n= 91) or placebo (n= 82). Methods: Women underwent LAVH for symptomatic uterine myomas and were randomly assigned to receive either rectal misoprostol (400 μg) and intravenous oxytocin (10 IU/hour) or placebo during LAVH. Parameters related to surgical outcome were compared. Main outcome measures: The main outcome measure was intra-operative blood loss. Results: Patient characteristics and indications for LAVH were similar in both groups. Mean [SD] for all continuous data estimated weight of blood loss (198.1 [123.2] vs 396 [337.6] g; P < 0.0001), mean operation time (106.2 [39.4] vs 116.6 [34.6] minutes; P= 0.02), mean change in haemoglobin (1.5 [1.0] vs 1.9 [1.2] g/dL; P= 0.02) and haematocrit levels (4.8 [2.9]% vs 5.8 [3.6]%; P= 0.04) and mean hospitalisation period (3.3 [0.8] vs 3.9 [1.1] days; P < 0.0001), which were significantly less in the group given rectal misoprostol and intravenous oxytocin than in the placebo group, respectively. There was no significant difference in complications and side effects between the two groups (P > 0.05). Conclusion: Combined rectal misoprostol and intravenous oxytocin is a feasible and effective method of reducing blood loss and operation time in LAVH.