Description
ABSTRACT
Background: There are myriads of measures employed by surgeons and anaesthetists in the reduction of blood loss during abdominal myomectomy, examples of which are performing the surgery during the proliferative phase of the woman’s menstrual cycle, optimizing her packed cell volume, haemodilution or preloading prior to the surgery, use of torniquet applied at the internal os just to mention a few. In addition, in challenging situations such as in Jehovah’s witnesses who do not accept blood transfusion the use of tranexamic acid, carbetocin and prostaglandin-E1 (misoprostol) employed for the reduction of blood loss during myomectomy.
Aim: To report a case of abdominal myomectomy and create awareness on the use of intraoperative intravenous tranexamic acid, intravenous carbetocin and rectal misoprostol in blood reduction during the surgery.
Case Report: She was a 30 year old P0+3 with tertiary level of education, single, and of the Jehovah’s Witness faith. Her Last menstrual period was on 1st may 2019. She presented with a 1-year history of progressive abdominal swelling to the gynaecological clinic. On examination she was not pale, revealed a healthy looking young woman
Her abdomen was distended, with abdomino-pelvic mass compartible with to a 22 weeks size gravid uterus, the mass was firm, nodula in consistencyVaginal examination revealed 20 weeks uterine size,
An impression of a huge uterine fibroid was made. She was counselled also signed the power of attorney for health care prohibiting blood transfusion. Pelvic ultrasound scan done showed solitary intramural myoma measuring 11cm by 10 cm. Pre-operative Haemoglobin concentration was 11.8g/dl other investigations were normal. She had 2 units of compartible blood grouped and cross matched for her.
Abdominal myomectomy was done under regional anaesthesia, 2g of IV Tranexamic acid 100ug of IV Carbetocin were administered intra-operatively as well as rectal misoprostol 600ug with enucleation of 12cm by 10 cm intra-mural myoma which weighed 2.5 Kg. The estimated blood loss was 200mls. Her postoperative period was uneventful. Her post-operative haemoglobin concentration was 11.0 g/dl. Patient was discharged on the 5th post-operative day, she was in satisfactory clinical condition 2 weeks post-operatively.
Conclusion: The case report revealed the role of tranexamic acid, carbetocin and misoprostol in the reduction of blood loss during myomectomy. Case series and comparative studies are recommended to strengthen the evidence of this case report. This is because blood loss during abdominal myomectomy is a challenge to care givers as well as in peculiar scenarios such as Jehovah’s witnesses who do not accept blood transfusion.
Key words: Tranexamic acid, Carbetocin, Misoprostol, Abdominal, Myomectomy
