Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study

ObjectiveTo determine the effect of a single preoperative intravaginal prostaglandin E2 (PGE2; dinoprostone) suppository on reducing intraoperative blood loss and the need for subsequent blood transfusion at abdominal myomectomy for symptomatic leiomyomas.Study designIn a prospective randomized double-blind placebo-controlled pilot study, 108 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to receive a single dose of intravaginal 20 mg dinoprostone (n = 54) or placebo (n = 54) 60 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) level 24 h after operation, and the prevalence of side effects.ResultsBlood loss and transfusion rate were significantly greater in the group without PGE2 suppository (group B) than in the group with PGE2 (group A): they were respectively 485.7 ± 361.3 mL vs 364.1 ± 279.4 mL (P = .02; relative risk [RR] 0.95; 95% confidence interval [CI], 0.63–1.45) and 18.5% vs 3.7% (P = .04; RR 1.32; 95% CI, 3.7–18.5). Group B had a significant decrease in Hb level 24 h after operation compared with group A (P < .05). There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups.ConclusionA single pre-operative dose of dinoprostone administered intravaginally could be a safe and reliable method to help decrease blood loss during abdominal myomectomy. Further larger prospective studies are required to support this conclusion.