الفهرس 
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Abstract
In this clinical randomized controlled trial, 120 patients with symptomatic uterine leiomyoma underwent abdominal myomectomy and were randomly assigned to one of three equal treatment groups: group I received preoperative vaginal misoprostol 400 mcg two hours before the procedure; group II received an intraoperative pericervical hemostatic tourniquet; and group III served as the control group, undergoing surgery without any additional intervention. Following approval from the department’s local ethical committee on November 21, 2021, patients were enrolled and assessed for eligibility from the Obstetrics and Gynecology department at Minia University Maternity Hospital [MUMH] between January and December 2022.
All women who fulfilled the following criteria were included in the study; women with symptomatic uterine leiomyoma candidate for abdominal myomectomy, woman aged >18 years old, non-pregnant, comparable criteria of myoma as (not exceeding 3 in number, size <5cm, not overlying vascular structure), pre-operative hemoglobin concentration >10gm/dL and no disease affecting AMH levels as (ovarian tumor, polycystic ovarian syndrome, history of ovarian factor infertility).
This study concluded that:
• Abdominal myomectomy without intervention (either medically with misoprostol or non-medically with a tourniquet) is associated with complications, particularly blood loss.
• The intraoperative pericervical hemostatic tourniquet, followed by preoperative vaginal misoprostol medication, is more effective at reducing blood loss during abdominal myomectomy than the non-intervention method.
• Less patients in the misopristol and tourniquet groups needed blood transfusions when compared to the control group.
• Both the tourniquet group and the misoprostol group had quicker operating times than the control group.
• The length of hospital stays did not differ across the three groups.
• Only a small percentage of patients reported experiencing pyrexia, diarrhea, shivering, nausea, and other misoprostol adverse effects.
• Preoperative 400mcg vaginal misoprostol is an effective and safe method for reducing blood loss during transabdominal myomectomy.
• Preoperative 400mcg vaginal misoprostol is comparable with peri-cervical tourniquet in reducing blood loss during transabdominal myomectomy.