Uterine leiomyomas (fibroids or myomas) are benign, smooth muscle tumors of the human uterus.
Most myomas are asymptomatic (symptomless) and are discovered incidentally during a routine
pelvic examination or imaging studies and have a lifetime incidence of approximately 70% in
the general population . However, Approximately 20-40% of women with fibroids experience
significant symptoms and consult gynecologic care. The most common clinical symptoms include
abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility, and recurrent pregnancy
loss
The standard treatment of symptomatic leiomyomas is Abdominal myomectomy Blood loss during
myomectomy can be intra-operative or postoperative and with hematoma formation. The average
volume of blood loss during abdominal myomectomy is 200 to 800 ml. massive blood loss
associated with the dissection of huge fibroids renders myomectomy a more technically
challenging procedure than hysterectomy. Sometimes myomectomy is converted to hysterectomy
intra-operatively when bleeding becomes heavy and uncontrollable or when it is impossible to
reconstruct the uterus because of the many defects left by removal of multiple myomas .
Many techniques are used to reduce blood loss during myomectomy; preoperative measures such
as correction of preoperative anemia associated with menorrhagia may be treated with iron
supplementation, use of gonadotropin (GHG) triggers prior to surgery. Intra-operative
measures as use of tourniquet around the uterus during the operation, injections of
Vasopressin or other vasopressors as epinephrine in the uterine muscle and use of ecbolic
(misoprostol, oxytocin, and carbetocin etc.). Uterine artery ligation, embolization, or
internal iliac artery ligation may also be used to avoid hysterectomy when heavy bleeding is
anticipated or occurs during myomectomy