ORIGINAL ARTICLE Rectal misoprostol plus perivascular vasopressin versus tourniquet to decrease blood loss during abdominal myomectomy Ibrahim Abd Elgafor El Sharkwy 1 & Mohamed Lotfy 1 & Hussein Mohamed Abdeldayem 1 & Ali Abdel Hameed 1 Received: 17 November 2015 /Accepted: 10 May 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract The aim of this study is to compare between com- bined preoperative rectal misoprostol plus perivascular vaso- pressin and tourniquet to decrease blood loss during abdomi- nal myomectomy. In this randomized study, 104 patients were randomly allocated to receive either combined 400 μg rectal misoprostol plus perivascular vasopressin (n = 52) or tourni- quet (n =52). The main outcome measure was the operative blood loss. Secondary outcome measures included the re- quirement for blood transfusion, the change in hemoglobin level after operation, and incidence of complications. Blood loss was significantly greater in the group with tourniquet (375.7±292.3 mL) than in the group with rectal misoprostol plus perivascular vasopressin (254.1±185.4 mL) (P = 0.03). The group with tourniquet had a significant decrease in Hb level 24 h after operation (P < 0.04). Blood transfusion rate was significantly greater in the group with tourniquet (P <0.04). The febrile morbidity was comparable in the two groups. Rectal misoprostol plus perivascular vasopressin was found to be more effective than tourniquet for decreasing blood loss during abdominal myomectomy. Keywords Misoprostol . Vasopressin . Tourniquet . Abdominal myomectomy Introduction Leiomyoma uteri are the most frequent female genital tumors. Although most of them are asymptomatic [1]. About 20 to 50 % of leiomyomas will exist with symptoms severe enough to need treatment [2]. Uterine fibroids are mainly the most common cause for abdominal hysterectomy [ 3 ]. Myomectomy has increased due to the great advance in assisted reproductive techniques and the desire of many wom- en in late childbearing period to get pregnant [4]. Significant bleeding related to removal of large fibroids makes myomec- tomy a more difficult technique [5]. Numerous interferences have been presented to lessen blood loss at time of abdominal myomectomy. In spite of these actions, avoidance of too much blood loss during myomectomy remains a chief job for sur- geons [6]. It is recognized that misoprostol, a prostaglandin E1 analog, increases myometrial contractions and decreases uter- ine blood flow and subsequently may decrease blood loss at time of myomectomy [7]. Vasopressin stimulates uterine mus- cles contractions by acting through myometrial V1a receptors, which exist in the myometrium of both pregnant and non- pregnant uteri [8]. Mechanical tourniquets have been tradi- tionally used at time of myomectomy to decrease myometrial bleeding [9]. We hypothesized that addition of preoperative misoprostol to vasopressin may be a highly effective method in reducing blood loss, so in this study, we investigated the effectiveness of rectal misoprostol along with vasopressin compared with tourniquet for decreasing of bleeding during abdominal myomectomy. Patients and methods The current randomized controlled trial was carried out at the Department of Obstetrics and Gynecology, Zagazig University Hospital, Zagazig, Egypt. Approval of the Synopsis: Rectal misoprostol plus perivascular vasopressin was found to be more effective than pericervical tourniquet for decreasing blood loss during abdominal myomectomy. * Ibrahim Abd Elgafor El Sharkwy IbrahimSharkwy@yahoo.com 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt Gynecol Surg DOI 10.1007/s10397-016-0956-2