Introduction: Uterine myomas are most prevalent benign tumors in reproductive-aged women. Myomectomy is a surgical treatment for symptomatic uterine myomas for women who want to preserve fertility. Uncontrolled intraoperative bleeding with others life-threatening complications make the surgery risky even more than the hysterectomy and require a skilled surgeon, several methods have been developed to reduce this complications. Misoprostol PE1 analogue, which is recently used as treatment and prophylaxis of postpartum hemorrhage, may reduce intra-operative blood loss during abdominal myomectomies when bleeding constitutes a major problem. Aim of the work: Was to assess the effect part of a single dose of Misoprostol (400 microgram) given rectally one hour preoperative on the amount of blood loss during open Myomectomy. Patients and Methods: In a prospective randomized double-blind placebo-controlled trial which was conducted at Ain shams maternity Hospital in Cairo from October 2017 to May 2018, 50 women undergoing abdominal myomectomy for symptomatic uterine myomas were randomly divided into 2 groups : Group I (control group) consisted of 25 patients, each patient was given 2 tablets of placebo trans-rectally one hour preoperatively and without any intervention to reduce blood loss and Group II (study group) consisted of 25 patients, each patient was given 400 micrograms of misoprostol transrectally one hour preoperatively. The primary outcome was intraoperative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT03483142. Results: Intra-operative blood loss was significantly lower in those women randomized to receive rectal misoprostol versus the placebo group (460.8-155.2 mL vs. 815.4 -187.7 mL). Misoprostol group showed lower mean blood loss (P<0.01) ; additionally, there was a highly significant statistical difference between Misoprostol group and placebo group as regards the postoperative hemoglobin, hematocrit concentration, operative time and IV fluid infusion during surgery (P<0.01) as Misoprostol group showed a higher postoperative hemoglobin and hematocrit concentration, and less operative time and infused IV fluid. There was no statistical significant difference between both groups as regards the blood transfusion. Conclusion: Preoperative single dose of rectal misoprostol (400 micrograms) is an effective simple method for reducing intra-operative bleeding, operative time, mean post-operative HB and Hct drop.

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Background: High doses of iron lead to gastrointestinal intolerance suggesting some toxic effect on the gut mucosa that is probably mediated by iron-related oxidative stress. Aim : This study aimed to compare the hemoglobin levels in non anemic pregnant women receiving weekly versus daily iron supplementation. Material and Methods: This randomized controlled clinical trial was conducted One hundred and forty patients during the period from October 20017 to December 2018 at Ain-Shams University Maternity Hospital in the outpatient antenatal clinics. They were divided into two groups; group A (weekly group) received 2 capsules of 100 mg elemental iron (from 305 mg ferrous fumarate) plus 2 mg of folic acid (Ferro-6-Pharco-Egypt) once weekly and group B (daily group) received one capsule of 100 mg elemental iron (from 305 mg ferrous fumarate) plus 2 mg of folic acid (Ferro-6-Pharco-Egypt) once daily. Results: There was no statistically significant difference could be detected between both groups as regards the demographic data, body mass index, interval since last pregnancy, hemoglobin level before starting iron supplementation and duration of supplementation and this can be attributed to proper randomization. In this study, there was no statistically significant difference between both groups as regards the hemoglobin level after one month of iron supplementation and after three months of iron supplementation. Although the mean hemoglobin concentration at 36 weeks gestation was lower in the weekly supplementation group it did not reach the level of statistical significance. There was significant increase in the incidence of iron side-effects mainly gastrointestinal side-effects in the form of nausea, vomiting, constipation, heart burn and metallic taste. High doses of iron lead to gastrointestinal intolerance. There was no statistically significant difference could be detected between both groups as regards the fetal weight. Conclusion:Weekly iron supplementation as a prophylaxis in non-anemic pregnant women is as good as daily supplementation as regards the hemoglobin level in addition; it was associated with significantly fewer side-effects and much better compliance.

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