Color Doppler Misoprostol Response Study (CDMRS): An Evaluation Tool for Patients Awaiting Myomectomy

Uterine myomas (fibroids) are benign tumors of the uterus. Myomectomy, the surgical removal of myoma, is an important treatment option. The major complication associated with myomectomy is excessive bleeding. Many interventions have been used to reduce bleeding during myomectomy. Misoprostol produces uterine contraction, thereby reducing blood supply to the myometrium and in the myoma; it can be used as an alternative to uterine artery occlusion or paracervical tourniquet to reduce blood flow during myomectomy. The Color Doppler Misoprostol Response Study (CDMRS) is a study planned to assess the vascularity of the myoma in patients with fibroid uterus and note the changes after misoprostol administration. A baseline study of all the patients was done prior to insertion of misoprostol or placebo, and the largest selected fibroid in the patients with uterine fibroids was evaluated for its volume and perfusion by Doppler ultrasound. The resistive index (RI) was measured prior to and after administration of 800 μg misoprostol (4 tablets) per rectal insertion, after 20 minutes, and reevaluated 40 minutes postinsertion. Results from a t-test shows that the use of misoprostol significantly reduces the volume of fibroid from 0–20 minutes by t0–20 [mean difference = 40.3 cm3, confidence interval (CI) 30.6–49.9, p = 0.000) and t20–40 (mean difference = 36.2 cm3, 95% CI 30.7−41.6 cm3, p = 0.000). In the control group receiving four tablets of placebo no significant difference was noted in volume of the fibroid. Likewise, when we compared the RIs at different timings, the results were again in favor of misoprostol because the blood flow of myomas was substantially reduced. The RI increased from t0–20 (mean difference = 0.26, 95% CI 0.16 cm3–0.38 cm3, p = 0.000) and t20-40 (mean difference = 0.08, 95% CI 0.33−0.04 cm3, p = 0.000). In the control group receiving four tablets of placebo, no significant difference was noted in perfusion of the fibroid. In conclusion, we suggest that all patients scheduled for myomectomy have prior CDMRS to evaluate the degree of vascularity and to assess if they have an appropriate response to misoprostol administered rectally, so that there is minimal or no blood loss during surgery. This preoperative assessment will decrease physician apprehension, with less intraoperative blood loss and morbidity.