Abstract: Objective To investigate the hemostatic efficacy of carboprost tromethamine in multiple myomectomy and to analyze factors influencing patient prognosis. Methods A single-center randomized controlled cohort study was conducted. A total of 244 patients who underwent multiple myomectomy at The Fourth Affiliated Hospital of Nanjing Medical University from January 1, 2020, to December 31, 2022, were enrolled. They were randomly assigned using a random number table generated by SAS software to an intervention group (n = 123), which received carboprost tromethamine injection for hemostasis, or a control group (n = 123), which received oxytocin injection for hemostasis. The therapeutic outcomes were compared between groups. Recurrence was assessed after a 24-month follow-up, and influencing factors were analyzed. Results There were statistically significant differences between the intervention group and the control group in intraoperative blood loss and the difference in hemoglobin levels between preoperatively and 3 days postoperatively (P＜0.05). No statistically significant differences were found in operative time, time to ambulation, time to first flatus, length of hospital stay, or changes in C-reactive protein, luteinizing hormone, and follicle-stimulating hormone levels (P ＞0.05). There were no statistically significant differences in adverse reactions between the two groups (P ＞0.05). During follow-up, 92 patients experienced recurrence. Multivariate analysis revealed age, age at menarche, postoperative gonadotropin releasing hormone analogue （GnRH-a）treatment, and the number of fibroids as independent risk factors for recurrence (P＜0.05). A nomogram prediction model was constructed, indicating that within a total score range of 20 ~ 100 points, a higher score was associated with an increased recurrence risk. The receiver operating characteristic curve indicated good discriminative ability of the model. The Hosmer-Lemeshow test demonstrated good calibration, and clinical decision curve analysis showed that the nomogram prediction model had good clinical utility when the threshold probability was ＞ 0.05. Conclusion Carboprost tromethamine demonstrates good hemostatic efficacy in multiple myomectomy. Age, the number of fibroids, age at menarche, and postoperative GnRH-a treatment are significant factors influencing recurrence. The constructed nomogram prediction model exhibits good discrimination, calibration, and clinical utility.