International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 181–192

DOI: 10.46882/2026/IJOG/000492

Original Research Article

Title: Evaluation of Single-Cell RNA Sequencing for the Identification of Endometrial Receptivity Biomarkers in Patients with Recurrent Implantation Failure

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:
Recurrent Implantation Failure (RIF) remains a substantial barrier to successful in vitro fertilization cycles. This prospective case-control study utilized single-cell RNA sequencing (scRNA-seq) to profile the transcriptomic landscape of endometrial biopsies during the mid-luteal implantation window to discover novel cell-specific biomarkers of endometrial receptivity. Endometrial tissue samples were collected on day LH+7 from 30 women diagnosed with RIF and 30 fertile controls. High-throughput scRNA-seq mapped the gene expression profiles of epithelial, stromal, endothelial, and immune cell populations. Computational analysis revealed a distinct transcriptomic dysregulation in the luminal and glandular epithelial cells of RIF patients. Specifically, a total of 45 genes associated with cell adhesion and ciliogenesis, including PAX8, GPX3, and HOXA10, were significantly downregulated in the RIF cohort compared to controls (p < 0.001). Conversely, pro-inflammatory chemokine genes (CXCL14 and CCL4) were overexpressed in the stromal compartments of RIF biopsies. A predictive model constructed using an 8-gene epithelial transcriptomic panel achieved a diagnostic sensitivity of 90.0% and a specificity of 86.7% (Area Under the Curve [AUC] = 0.92) for identifying impaired endometrial receptivity. In conclusion, single-cell RNA sequencing highlights distinct cell-type-specific molecular abnormalities in women experiencing recurrent implantation failure, offering a highly accurate diagnostic panel to optimize personalized embryo transfer timing.

Keywords: Recurrent Implantation Failure; Endometrial Receptivity; Single-Cell RNA Sequencing; Implantation Window; Transcriptomics; Biomarkers.

Manuscript Timeline: Received: April 28, 2026; Revised: June 22, 2026; Accepted: July 15, 2026; Published: August 02, 2026.

Citation: Nwosu AP, Kudoyin ST. Evaluation of Single-Cell RNA Sequencing for the Identification of Endometrial Receptivity Biomarkers in Patients with Recurrent Implantation Failure. International Journal of Obstetrics and Gynecology. 2026; 14(8): 181–192

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 193–204

DOI: 10.46882/2026/IJOG/000493

Original Research Article

Title: A Randomized Trial of Laparoscopic Sacropexy versus Transvaginal Mesh for High-Grade Apical Pelvic Organ Prolapse

Names of Authors: Kofi A. Mensah¹

Authors’ Affiliations:
¹ Urogynecology Unit, Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana

Abstract:
The ideal surgical approach for severe apical pelvic organ prolapse remains widely debated due to balance requirements between anatomical durability and complication profiles. This randomized clinical trial compared the 3-year anatomical success rates, functional outcomes, and adverse events of Laparoscopic Sacrocolpopexy/Sacropexy (LSP) versus Transvaginal Mesh (TVM) placement. One hundred and sixty postmenopausal women presenting with symptomatic stage III or IV apical prolapse were randomized into two equal groups (n = 80 per group). The primary outcome was objective anatomical success defined as Pelvic Organ Prolapse Quantification (POP-Q) stage 0 or I at the apical compartment 36 months postoperatively. At the 3-year mark, LSP demonstrated a significantly higher objective anatomical success rate compared to the TVM group (93.8% vs. 81.3%, p = 0.018). Subjective symptom improvement, measured via the Pelvic Floor Distress Inventory (PFDI-20), was high in both cohorts (p < 0.001). However, the TVM group experienced a significantly higher incidence of mesh exposure/erosion into the vaginal epithelium compared to the LSP arm (11.3% vs. 1.3%, p = 0.009), frequently necessitating secondary surgical excision. Dyspareunia rates were also higher after TVM procedures (15.4% vs. 3.8%, p = 0.034). Operative time was shorter in the transvaginal approach (54.2 ± 12.5 minutes vs. 112.6 ± 24.8 minutes, p < 0.001). Laparoscopic sacropexy provides superior long-term structural durability and a lower complication rate for advanced apical pelvic organ prolapse compared to transvaginal mesh, supporting its use as a preferred intervention in eligible surgical candidates.

Keywords: Pelvic Organ Prolapse; Apical Suspension; Laparoscopic Sacrocolpopexy; Transvaginal Mesh; Mesh Erosion; Dyspareunia.

Manuscript Timeline: Received: May 02, 2026; Revised: June 25, 2026; Accepted: July 18, 2026; Published: August 04, 2026.

Citation: Mensah KA. A Randomized Trial of Laparoscopic Sacropexy versus Transvaginal Mesh for High-Grade Apical Pelvic Organ Prolapse. International Journal of Obstetrics and Gynecology. 2026; 14(8): 193–204.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 133–144

DOI: 10.46882/2026/IJOG/000488

Original Research Article

Title: Efficacy of Vaginal Progesterone versus Cervical Pessary in Preventing Preterm Delivery in Asymptomatic Twin Pregnancies with a Short Cervix

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

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

Abstract:
Twin pregnancies present an inherently heightened risk of spontaneous preterm birth, which is further exacerbated by the presence of a shortened cervix. This randomized clinical trial compared the efficacy of daily vaginal progesterone against a cervical Arabin pessary for preventing preterm birth before 34 weeks of gestation in asymptomatic twin pregnancies with a transvaginal ultrasound cervical length ≤ 25 mm. One hundred and forty women with twin gestations identified with a short cervix during mid-trimester screening (18 to 22 weeks) were randomized to receive either vaginal progesterone (200 mg capsules daily, n = 70) or a cervical pessary (n = 70) up to 36 completed weeks. The primary outcome evaluated was delivery before 34 completed weeks. The incidence of preterm delivery before 34 weeks did not differ significantly between the vaginal progesterone and cervical pessary groups (21.4% vs. 24.3%; Relative Risk [RR] = 0.88; 95% CI, 0.48 to 1.61; p = 0.69). Mean gestational age at delivery was comparable between both arms (34.6 ± 1.8 weeks vs. 34.2 ± 2.1 weeks, p = 0.24). Neonatal outcomes, including mean birth weight, respiratory distress syndrome, and admission rates to neonatal intensive care units, were statistically similar (p > 0.05). Vaginal discharge was reported significantly more often in the progesterone cohort, while increased vaginal discomfort was noted in the pessary group. Vaginal progesterone capsules and cervical pessary placement offer equivalent clinical efficacy and safety profiles for managing twin pregnancies complicated by a shortened cervix.

Keywords: Twin Pregnancy; Short Cervix; Preterm Birth; Vaginal Progesterone; Cervical Pessary; Neonatal Outcomes.

Manuscript Timeline: Received: April 22, 2026; Revised: June 15, 2026; Accepted: July 12, 2026; Published: August 25, 2026.

Citation: Nwosu AP, Kudoyin ST. Efficacy of Vaginal Progesterone versus Cervical Pessary in Preventing Preterm Delivery in Asymptomatic Twin Pregnancies with a Short Cervix. International Journal of Obstetrics and Gynecology. 2026; 14(8): 133–144.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 121–132

DOI: 10.46882/2026/IJOG/000487

Original Research Article

Title: A Randomized Controlled Trial of Microwave Endometrial Ablation versus Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding

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:
Heavy Menstrual Bleeding (HMB) severely diminishes women's health status and productivity. This multi-center randomized controlled trial compared the 2-year therapeutic efficacy, patient satisfaction, and complication rates of Microwave Endometrial Ablation (MEA) against the Levonorgestrel-Releasing Intrauterine System (LNG-IUS) in women with idiopathic HMB. Two hundred premenopausal women aged 35 to 48 years who failed initial first-line medical therapies were randomized to undergo either MEA (n = 100) or LNG-IUS insertion (n = 100). The primary outcome was measured as changes in menstrual blood loss using the pictorial blood loss assessment chart (PBAC) score at 12 and 24 months. Both interventions yielded a dramatic reduction in PBAC scores from baseline (p < 0.001). At 24 months, amenorrhea rates were significantly higher in the MEA group compared to the LNG-IUS cohort (64.0% vs. 41.0%, p = 0.002). The total treatment satisfaction score was slightly higher in the surgical ablation group (91.0% vs. 82.0%, p = 0.041). Treatment failure leading to alternative surgical procedures or hysterectomy occurred in 4.0% of the MEA cohort and 11.0% of the LNG-IUS cohort (p = 0.048), mostly driven by displacement or persistent breakthrough spotting in the device arm. Mild procedural pain and transient cramping were the most common complaints for MEA and LNG-IUS, respectively. Microwave endometrial ablation provides a highly effective, definitive non-incisional treatment for idiopathic heavy menstrual bleeding, demonstrating higher long-term amenorrhea rates and superior treatment compliance compared to the levonorgestrel intrauterine system.

Keywords: Heavy Menstrual Bleeding; Endometrial Ablation; Microwave Ablation; Levonorgestrel Intrauterine System; Amenorrhea; Treatment Satisfaction.

Manuscript Timeline: Received: April 15, 2026; Revised: June 11, 2026; Accepted: July 05, 2026; Published: August 14, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. A Randomized Controlled Trial of Microwave Endometrial Ablation versus Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding. International Journal of Obstetrics and Gynecology. 2026; 14(8): 121–132.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 109–120

DOI: 10.46882/2026/IJOG/000486

Original Research Article

Title: Diagnostic Performance of Machine Learning Models Analyzing Cardiotocography for Intrapallial Fetal Acidosis Detection

Names of Authors: Fatima B. Aliyu¹, Tunde M. Bakare¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria

Abstract:
Intrapartum cardiotocography (CTG) interpretation is prone to high inter-observer variability, often contributing to unnecessary operative deliveries or delayed interventions for fetal distress. This retrospective diagnostic accuracy study assessed a machine learning (ML) framework developed to interpret intrapartum CTG traces for the prediction of neonatal umbilical artery academia (pH < 7.15). A database of 1,500 laboring traces recorded within 60 minutes prior to delivery was utilized to train and validate three ML models: Random Forest, Support Vector Machine, and a Deep Convolutional Neural Network (CNN). Performance metrics were checked against standard evaluations performed by expert obstetricians blinded to the clinical outcomes. The reference standard was newborn umbilical cord blood gas analysis. Neonatal acidosis (pH < 7.15) was present in 12.4% of cases. The deep CNN model outperformed both the alternative ML algorithms and clinical observers, demonstrating a sensitivity of 86.4%, a specificity of 91.2%, a positive predictive value of 62.4%, and a negative predictive value of 97.4% (Area Under the Curve [AUC] = 0.93). In comparison, visual expert interpretation according to traditional guidelines achieved a sensitivity of 61.2% and a specificity of 76.5% (p < 0.001), showing a higher rate of false-positive indications for emergency interventions. Automated ML analysis of intrapartum cardiotocography features substantially increases the detection of intrapartum fetal acidosis while providing a robust diagnostic baseline to lower false-positive interpretations and avoidable surgical deliveries.

Keywords: Cardiotocography; Machine Learning; Deep Learning; Fetal Acidosis; Intrapartum Surveillance; Umbilical Cord pH.

Manuscript Timeline: Received: April 11, 2026; Revised: June 03, 2026; Accepted: July 01, 2026; Published: August 05, 2026.

Citation: Aliyu FB, Bakare TM. Diagnostic Performance of Machine Learning Models Analyzing Cardiotocography for Intrapallial Fetal Acidosis Detection. International Journal of Obstetrics and Gynecology. 2026; 14(8): 109–120.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 7, July 2026 | pp. 97–108

DOI: 10.46882/2026/IJOG/000485

Original Research Article

Title: Evaluation of Prophylactic Tranexamic Acid in Lowering Blood Loss during Elective Cesarean Section: A Double-Blind Randomized Controlled Trial

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:
Cesarean section carries a baseline hemorrhage risk that significantly exceeds that of normal vaginal birth. This double-blind, placebo-controlled randomized trial investigated the efficacy and clinical safety of prophylactic intravenous tranexamic acid (TXA) in minimizing blood loss during and after elective cesarean deliveries. Three hundred and forty low-risk pregnant women at term scheduled for elective cesarean delivery under spinal anesthesia were randomized to receive either 1 g of intravenous TXA (n = 170) or a matching 0.9% saline placebo (n = 170) administered slowly 10 minutes prior to skin incision. Standard active management with oxytocin infusion was maintained in both arms. The primary outcome was the total calculated blood loss from the start of the incision until 2 hours postpartum, measured via gravimetric methods and hemoglobin drop. The mean total blood loss was significantly lower in the TXA group compared to the placebo group (385.4 ± 110.2 mL vs. 512.6 ± 145.8 mL, p < 0.001). The mean postpartum hemoglobin drop measured 24 hours after surgery was also significantly less in the TXA cohort (0.65 ± 0.22 g/dL vs. 1.15 ± 0.35 g/dL, p < 0.001). Only 1.2% of patients in the TXA arm experienced blood loss > 1,000 mL, compared to 5.9% in the placebo arm (p = 0.024). No thrombotic complications or serious drug-related maternal-fetal adverse events were noted up to 6 weeks postpartum (p > 0.05). Prophylactic administration of tranexamic acid significantly reduces blood loss and limits hemoglobin drops in women undergoing elective cesarean delivery without increasing hypercoagulable risks.

Keywords: Tranexamic Acid; Cesarean Section; Postpartum Hemorrhage; Blood Loss; Hemoglobin Drop; Prophylaxis.

Manuscript Timeline: Received: March 25, 2026; Revised: May 15, 2026; Accepted: June 14, 2026; Published: July 24, 2026.

Citation: Sanusi IK, Nwachukwu CJ. Evaluation of Prophylactic Tranexamic Acid in Lowering Blood Loss during Elective Cesarean Section: A Double-Blind Randomized Controlled Trial. International Journal of Obstetrics and Gynecology. 2026; 14(7): 97–108.