Intravenous Tranexamic Acid Versus Pericervical Tourniquet To Decrease Blood Loss In Trans-Abdominal Myomectomy

Inclusion Criteria: * • Women in the reproductive age (20 - 40 years) diagnosed as having uterine fibroids who are consenting to have trans-abdominal myomectomy in the postmenstrual period diagnosed by: Clinical symptoms and signs: * Abnormal uterine bleeding (menorrhagia or (and) metrorrhagia). * Pain (dull aching lower abdominal pain or dysmenorrhea). * Pressure symptoms (dyspareunia, dysuria, dyschezia or (and) backache). * Progressive abdominal enlargement (abdominal swelling). All women with clinical presentation suggestive of uterine fibroid will undergo abdominal and trans-vaginal ultrasound to confirm the clinical diagnosis and to exclude patients with: * Submucous uterine myomas. * Cervical or supracervical myomas. * Broad ligamentary and pedunculated myomas. * Associated pelvic pathology. Ultrasound criteria of uterine fibroids of included patients: * Maximum diameter of the largest fibroid is greater than 4cm. * Maximum number of uterine myomas is not to be more than 5 myomas. * Uterine fibroid may be subserous or intramural. Exclusion Criteria: * Obesity (body mass index \>30 kg/m2). * Cardiac, endocrine, pulmonary or hematological disease (including anemia; hemoglobin level below 10gm/dl). * Patients known to be allergic to tranexamic acid. * Patients who received pre-operative hormonal therapy (such as a GnRH analogue). * Patients presented by or with suspected malignant gynecological disease. * Patients diagnosed as having submucous uterine fibroids, c…