International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 337–348

DOI: 10.46882/2026/IJOG/000505

Original Research Article

Title: Evaluation of Single-Dose Oral Cetrorelix versus Depository Leuprolide Acetate for the Medical Management of Symptomatic Uterine Leiomyomas

Names of Authors: Mariam T. Bello¹, Grace E. Effiong²

Authors’ Affiliations:
¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
² Department of Public Health, University of Calabar, Calabar, Nigeria

Abstract:
Injectable gonadotropin-releasing hormone (GnRH) agonists are widely used to reduce fibroid volume but trigger initial hormonal flare-ups and severe hypoestrogenic side effects. This randomized active-controlled study evaluated the clinical efficacy, fibroid volume reduction, and safety of an oral, non-peptide GnRH antagonist, cetrorelix, compared to monthly intramuscular leuprolide acetate deposits. One hundred and forty premenopausal women presenting with heavy menstrual bleeding due to uterine leiomyomas were randomized into two equal groups (n = 70 per group) for a treatment duration of 12 weeks. The primary endpoints were the percentage reduction in total fibroid volume and the control of menorrhagia. At week 12, the mean reduction in the volume of the dominant fibroid was 44.5% ± 8.4% in the oral cetrorelix group and 48.2% ± 9.1% in the leuprolide acetate cohort, demonstrating therapeutic equivalence (p = 0.12). Menorrhagia scores improved substantially in both groups within 4 weeks (p < 0.001). However, the oral cetrorelix cohort reported a significantly faster onset of symptom relief due to the immediate avoidance of a flare effect (p = 0.004). Furthermore, mean bone mineral density drops were significantly less pronounced in the cetrorelix arm (-0.4% vs. -1.8%, p = 0.008), and vasomotor symptom scores (hot flashes) were less severe. Daily oral cetrorelix serves as an efficient non-invasive therapeutic option for symptomatic uterine fibroids, providing swift volume reduction and menorrhagia resolution with an improved safety profile compared to long-acting GnRH agonists.

Keywords: Uterine Leiomyoma; GnRH Antagonist; Cetrorelix; Leuprolide Acetate; Fibroid Volume; Menorrhagia.

Manuscript Timeline: Received: May 20, 2026; Revised: July 10, 2026; Accepted: August 01, 2026; Published: August 12, 2026.

Citation: Bello MT, Effiong GE. Evaluation of Single-Dose Oral Cetrorelix versus Depository Leuprolide Acetate for the Medical Management of Symptomatic Uterine Leiomyomas. International Journal of Obstetrics and Gynecology. 2026; 14(8): 337–348.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 325–336

DOI: 10.46882/2026/IJOG/000504

Original Research Article

Title: Predictive Modeling of Preterm Birth Risk utilizing Multi-Omic Vaginal Biomarkers and Machine Learning Algorithms

Names of Authors: Oluwaseun A. Adebayo¹, Chinedu O. Okafor², Aminat Z. Yusuf¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
² Department of Maternal-Fetal Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

Abstract:
Spontaneous Preterm Birth (sPTB) is driven by diverse pathogenic pathways that are often inadequately captured by single clinical screening variables. This prospective cohort study investigated the predictive value of combining vaginal microbiome profiling, cervicovaginal fluid cytokines, and machine learning models to identify women at risk for spontaneous preterm birth prior to 34 weeks of gestation. Vaginal swabs were obtained from 500 asymptomatic singleton pregnancies between 16 and 20 weeks. Microbial compositions were identified through 16S rRNA gene sequencing, while cytokine concentrations (IL-1beta, IL-6, and TNF-alpha) were quantified via enzyme-linked immunosorbent assay. Predictive risk classification was performed using a Random Forest algorithm compared against standard cervical length screening (≤ 25 mm). Forty-five women (9.0%) delivered spontaneously before 34 weeks. The multi-omic machine learning classifier achieved a high predictive performance, yielding a sensitivity of 88.9%, a specificity of 92.3%, and an Area Under the Curve (AUC) of 0.94. Key predictive features included high relative abundances of Gardnerella vaginalis and Prevotella, coupled with elevated cervicovaginal fluid IL-6 concentrations (> 250 pg/mL) and a shortened cervical length. In contrast, utilizing cervical length measurements alone produced a sensitivity of 53.3% and a specificity of 86.8% (p < 0.001). Integrating cervicovaginal multi-omic data with machine learning algorithms provides a highly accurate, individualized screening framework for spontaneous preterm birth, facilitating targeted prophylactic strategies during early gestation.

Keywords: Spontaneous Preterm Birth; Vaginal Microbiome; Cytokines; Machine Learning; Random Forest; Risk Stratification.

Manuscript Timeline: Received: May 17, 2026; Revised: July 08, 2026; Accepted: July 30, 2026; Published: August 09, 2026.

Citation: Adebayo OA, Okafor CO, Yusuf AZ. Predictive Modeling of Preterm Birth Risk utilizing Multi-Omic Vaginal Biomarkers and Machine Learning Algorithms. International Journal of Obstetrics and Gynecology. 2026; 14(8): 325–336.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 313–324

DOI: 10.46882/2026/IJOG/000503

Original Research Article

Title: A Randomized Controlled Trial of Intrauterine Infusion of Human Chorionic Gonadotropin Prior to Embryo Transfer in Patients with Multiple IVF Failures

Names of Authors: Ibrahim K. Sanusi¹, Chioma J. Nwachukwu¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Abstract:
Impaired cross-talk between the blastocyst and maternal endometrium contributes significantly to recurrent implantation failure. This double-blind, randomized controlled trial evaluated whether an intrauterine infusion of human chorionic gonadotropin (hCG) immediately before embryo transfer influences implantation and clinical pregnancy rates in women with at least three prior failed in vitro fertilization (IVF) cycles. Two hundred subfertile women scheduled for fresh or frozen cleavage-stage embryo transfer were randomized to either the intervention group (n = 100) or the control group (n = 100). The intervention cohort received an intrauterine infusion of 500 IU of recombinant hCG diluted in 0.1 mL of culture medium 3 minutes prior to embryo transfer. The control group received an infusion of 0.1 mL of culture medium alone. The primary outcome was the clinical pregnancy rate confirmed via transvaginal ultrasound at 7 weeks. The clinical pregnancy rate was significantly higher in the intrauterine hCG group compared to the control group (39.0% vs. 24.0%; Odds Ratio [OR] = 2.03; 95% CI, 1.10 to 3.74; p = 0.023). Implantation rates were also significantly improved in the hCG-treated cohort (22.5% vs. 13.4%, p = 0.011). No cases of pelvic infection or hypersensitivity reactions were observed in either group. Intrauterine infusion of 500 IU of human chorionic gonadotropin shortly before embryo transfer represents a safe, inexpensive, and efficient strategy to enhance endometrial receptivity and pregnancy rates in patients with recurrent implantation failures.

Keywords: In Vitro Fertilization; Recurrent Implantation Failure; Human Chorionic Gonadotropin; Intrauterine Infusion; Clinical Pregnancy Rate; Endometrial Receptivity.

Manuscript Timeline: Received: May 14, 2026; Revised: July 04, 2026; Accepted: July 28, 2026; Published: August 06, 2026.

Citation: Sanusi IK, Nwachukwu CJ. A Randomized Controlled Trial of Intrauterine Infusion of Human Chorionic Gonadotropin Prior to Embryo Transfer in Patients with Multiple IVF Failures. International Journal of Obstetrics and Gynecology. 2026; 14(8): 313–324.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 301–312

DOI: 10.46882/2026/IJOG/000502

Original Research Article

Title: Efficacy of Oral Micronized Progesterone versus Vaginal Progesterone Gel for Luteal Phase Support in Frozen Embryo Transfer Cycles

Names of Authors: Anita P. Nwosu¹, Samuel T. Kudoyin²

Authors’ Affiliations:
¹ Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Ikeja, Nigeria
² Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Luteal Phase Support (LPS) is crucial for optimizing endometrial receptivity during artificial frozen embryo transfer (FET) cycles. This prospective, randomized, open-label trial evaluated the clinical efficacy, safety, and patient compliance of oral micronized progesterone (combined with oral dydrogesterone) versus standard vaginal progesterone gel for LPS. A cohort of 320 infertile women undergoing programmed FET cycles with high-grade blastocysts was randomized into two equal groups (n = 160 per group). The oral group received 400 mg oral micronized progesterone daily combined with 10 mg dydrogesterone three times daily. The vaginal group received 90 mg vaginal progesterone gel 8% once daily. Both regimens were initiated on the day of endometrial transformation and continued until 10 weeks of gestation if pregnancy occurred. The primary endpoint was the ongoing pregnancy rate at 12 weeks. Results demonstrated that the ongoing pregnancy rate was statistically comparable between the oral and vaginal groups (46.3% vs. 44.4%; Relative Risk [RR] = 1.04; 95% Confidence Interval [CI], 0.82 to 1.32; p = 0.74). The live birth rates were also similar between the arms (38.8% vs. 36.9%, p = 0.73). However, patient satisfaction and compliance scores were significantly higher in the oral cohort due to the absence of local vaginal irritation and discharge (92.5% vs. 71.3%, p < 0.001). In conclusion, combined oral progesterone administration provides excellent clinical pregnancy outcomes equivalent to vaginal gel routines, offering a well-tolerated and preferred alternative for patients undergoing frozen embryo transfer.

Keywords: Luteal Phase Support; Frozen Embryo Transfer; Micronized Progesterone; Vaginal Gel; Ongoing Pregnancy Rate; Patient Compliance.

Manuscript Timeline: Received: May 11, 2026; Revised: July 02, 2026; Accepted: July 25, 2026; Published: August 03, 2026.

Citation: Nwosu AP, Kudoyin ST. Efficacy of Oral Micronized Progesterone versus Vaginal Progesterone Gel for Luteal Phase Support in Frozen Embryo Transfer Cycles. International Journal of Obstetrics and Gynecology. 2026; 14(8): 301–312.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 289–300

DOI: 10.46882/2026/IJOG/000501

Original Research Article

Title: Evaluation of Prophylactic Bakri Balloon Tamponade during Cesarean Delivery for Placenta Previa: A Randomized Controlled Trial

Names of Authors: Emeka J. Obi¹, Funmilayo R. Adeyemi², Zainab H. Dogara¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
² Maternal Health Division, Federal Ministry of Health, Abuja, Nigeria

Abstract:
Placenta previa is historically associated with severe intrapartum and postpartum hemorrhage originating from a poorly contractile lower uterine segment during cesarean section. This randomized controlled trial evaluated the efficacy of prophylactic Bakri balloon tamponade placement immediately following placental extraction during cesarean delivery for complete placenta previa. One hundred and twenty pregnant women undergoing scheduled cesarean sections for stable, complete placenta previa were randomized to either the prophylactic Bakri balloon group (n = 60) or the conventional management group (oxytocin plus standard surgical hemostatic sutures; n = 60). The primary outcome measured was total perioperative blood loss. The mean total intraoperative and postoperative blood loss was significantly lower in the Bakri balloon group compared to the control group (645.2 ± 180.4 mL vs. 985.6 ± 290.2 mL, p < 0.001). The requirement for emergency secondary interventions, such as uterine artery ligation or B-Lynch sutures, was significantly reduced in the balloon cohort (1.7% vs. 11.7%, p = 0.028). Blood transfusion requirements were also significantly decreased in the prophylactic intervention arm (5.0% vs. 18.3%, p = 0.024). There were no cases of balloon displacement, uterine rupture, or secondary pelvic infections requiring balloon removal in the intervention group. Prophylactic application of the Bakri balloon tamponade during cesarean sections for complete placenta previa is a safe, effective strategy that reduces perioperative blood loss and limits additional surgical interventions or blood transfusions.

Keywords: Placenta Previa; Bakri Balloon; Postpartum Hemorrhage; Cesarean Section; Balloon Tamponade; Blood Transfusion.

Manuscript Timeline: Received: May 28, 2026; Revised: July 19, 2026; Accepted: August 06, 2026; Published: August 30, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. Evaluation of Prophylactic Bakri Balloon Tamponade during Cesarean Delivery for Placenta Previa: A Randomized Controlled Trial. International Journal of Obstetrics and Gynecology. 2026; 14(8): 289–300.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 277–288

DOI: 10.46882/2026/IJOG/000500

Original Research Article

Title: A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Myomectomy for Symptomatic Uterine Fibroids

Names of Authors: Olayinka O. Cole¹, Nesta C. Chuka¹

Authors’ Affiliations:
¹ Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria

Abstract:
High-Intensity Focused Ultrasound (HIFU) represents a non-invasive thermal ablation technique expanding treatment options for uterine leiomyomas. This randomized controlled trial compared the clinical efficacy, improvement in quality of life, and safety profiles of ultrasound-guided HIFU versus standard Laparoscopic Myomectomy (LM) for symptomatic uterine fibroids. One hundred and forty premenopausal women with 1 to 3 symptomatic intramural fibroids (maximum diameter 5 to 9 cm) were randomized into two equal treatment arms (n = 70 per group). The primary outcomes checked at 12 months were the volume reduction rate of the primary fibroid and the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) score. At 12 months, the mean fibroid volume reduction rate was 62.4% ± 10.5% in the HIFU group, while the LM group achieved complete surgical removal (100%). Both interventions led to a significant, comparable improvement in the UFS-QOL symptom severity scores (p = 0.18). Crucially, the HIFU cohort experienced significantly shorter treatment and recovery times, with a median hospital stay of 6 hours compared to 48 hours for the LM group (p < 0.001). Major procedural complications (hemorrhage or pelvic infection) were absent in the HIFU group but occurred in 5.7% of the LM cohort (p = 0.041). Minor adverse events in the HIFU group included transient skin burns (2.9%) and mild pelvic pain. Non-invasive HIFU ablation offers clinical symptom relief and quality-of-life improvements comparable to laparoscopic myomectomy with fewer major complications and drastically reduced hospital stays.

Keywords: Uterine Fibroids; High-Intensity Focused Ultrasound; Laparoscopic Myomectomy; Symptom Severity; Quality of Life; Thermal Ablation.

Manuscript Timeline: Received: May 25, 2026; Revised: July 15, 2026; Accepted: August 04, 2026; Published: August 27, 2026.

Citation: Cole OO, Chuka NC. A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Myomectomy for Symptomatic Uterine Fibroids. International Journal of Obstetrics and Gynecology. 2026; 14(8): 277–288.