TITLE:
The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria
AUTHORS:
William Amebeobari Mube, Justina Omoikhefe Alegbeleye, Ngozi Clare Orazulike
KEYWORDS:
Uterine Tourniquet, Open Abdominal Myomectomy, Ovarian Reserve, Anti-Mullerian Hormone, Nigeria
JOURNAL NAME:
Advances in Reproductive Sciences,
Vol.12 No.1,
February
22,
2024
ABSTRACT: Background: The most common surgical
treatment for symptomatic uterine fibroids, particularly in women with
fertility concerns, is open myomectomy. Given the high vascularity of the
uterus, haemorrhage during the procedure is a serious risk that is often
mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the
effect of uterine artery occlusion with a tourniquet during open myomectomy on
ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials
and Methods: This was a prospective longitudinal study with a
quasi-experimental design and a convenient sampling technique. The study
enrolled 47 women who had abdominal myomectomy between September 1, 2021, and
March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples
were collected before anaesthesia was administered in theatre, on day two, and
three months after open abdominal myomectomy for anti-Mullerian hormone assay.
The data was collected using a semi-structured proforma, entered into an Excel
spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence
interval. Statistical significance level was set at 0.05. Results: The
pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine
tourniquet at myomectomy on the second day and three months later were 1.22 ±
1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically
significant change in AMH levels, and there was no statistically significant
relationship between blood loss and tourniquet time and AMH after open
abdominal myomectomy. Conclusion: The use
of a uterine tourniquet and blood loss during open myomectomy has no effect on
ovarian reserve.