International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1083–1094

DOI: 10.46882/2026/IJOG/000571

Original Research Article

Title: Intrauterine Infusion of Platelet-Rich Plasma versus Granulocyte Colony-Stimulating Factor for Refractory Thin Endometrium in IVF Cycles

Names of Authors: Frederik Poulsen¹, Mariana Silva²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
² Department of Obstetrics and Gynecology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Abstract:
A persistently thin endometrium (< 7 mm) severely impairs pregnancy rates during frozen embryo transfer (FET) cycles. This prospective comparative clinical trial investigated the therapeutic efficacy of local intrauterine infusions of autologous Platelet-Rich Plasma (PRP) versus recombinant Granulocyte Colony-Stimulating Factor (G-CSF) in expanding endometrial thickness. One hundred subfertile women with a history of recurrent thin endometrium despite maximal oral estradiol therapy were assigned to receive either intrauterine PRP infusions (two doses on cycle days 10 and 12; n = 50) or a single intrauterine G-CSF infusion (on cycle day 11; n = 50). Endometrial structural dynamics were tracked via transvaginal ultrasound. Mean endometrial thickness increased significantly in both arms from baseline (p < 0.001). However, the PRP group achieved a significantly greater mean endometrial thickness on the day of progesterone initiation compared to the G-CSF cohort (7.8 ± 0.5 mm vs. 7.1 ± 0.4 mm, p < 0.001). Cycle cancellation rates due to inadequate endometrial expansion were lower in the PRP branch (2.0% vs. 12.0%, p = 0.043). Crucially, the clinical pregnancy rate per embryo transfer trended higher in the PRP cohort (43.8% vs. 29.5%, p = 0.048). Intrauterine infusion of autologous platelet-rich plasma provides a superior mucosal proliferative effect, optimizing endometrial thickness and lowering cancellation metrics in thin-endometrium FET cycles compared to G-CSF.

Keywords: Thin Endometrium; Platelet-Rich Plasma; Granulocyte Colony-Stimulating Factor; Frozen Embryo Transfer; Endometrial Thickness; Assisted Reproduction.

Manuscript Timeline: Received: July 18, 2026; Revised: September 06, 2026; Accepted: September 19, 2026; Published: September 28, 2026.

Citation: Poulsen F, Silva M. Intrauterine Infusion of Platelet-Rich Plasma versus Granulocyte Colony-Stimulating Factor for Refractory Thin Endometrium in IVF Cycles. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1083–1094.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1071–1082

DOI: 10.46882/2026/IJOG/000570

Original Research Article

Title: Comparative Clinical Performance of Single-Port vNOTES versus Total Laparoscopic Hysterectomy for Large Uterine Adenomyosis

Names of Authors: Lucas de Vries¹, Min-Ah Cho²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
² Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea

Abstract:
Total hysterectomy for severe uterine adenomyosis is frequently hampered by globoid uterine expansion, intense vascularity, and posterior cul-de-sac structural alterations. This prospective comparative trial evaluated the perioperative outcomes and early recovery parameters of single-port Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) against conventional multi-port Total Laparoscopic Hysterectomy (TLH) for globally enlarged adenomyotic uteri. One hundred premenopausal women presenting with symptomatic adenomyosis (uterine weight estimated between 250 and 500 g) were randomized into two equal surgical cohorts (n = 50 per group). The primary endpoint was total operative duration. The mean operative duration was significantly shorter in the vNOTES group compared to the TLH group (58.4 ± 12.5 minutes vs. 84.6 ± 18.4 minutes, p < 0.001), as direct transvaginal access simplified uterine devascularization and extraction without requiring morcellation. Postoperative visual analog scale pain scores were lower in the vNOTES cohort at 12 hours (2.1 ± 0.4 vs. 4.2 ± 1.1, p < 0.001), resulting in a 45.0% reduction in postoperative opioid requirements. The median hospital recovery stay was shorter for vNOTES patients (12.4 hours vs. 28.5 hours, p = 0.004), with zero incidences of abdominal wound infection. Single-port vNOTES hysterectomy for large adenomyotic uteri represents an efficient technique that reduces operative times, limits early postoperative pain, and eliminates abdominal incisional complications compared to conventional laparoscopy.

Keywords: vNOTES; Laparoscopic Hysterectomy; Adenomyosis; Enlarged Uterus; Postoperative Pain; Minimally Invasive Surgery.

Manuscript Timeline: Received: July 15, 2026; Revised: September 05, 2026; Accepted: September 18, 2026; Published: September 27, 2026.

Citation: de Vries L, Cho MA. Comparative Clinical Performance of Single-Port vNOTES versus Total Laparoscopic Hysterectomy for Large Uterine Adenomyosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1071–1082.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1059–1070

DOI: 10.46882/2026/IJOG/000569

Original Research Article

Title: Predictive Modeling of Preeclampsia Subtypes Utilizing First-Trimester Circulating Exosomal MicroRNAs

Names of Authors: Camille Laurent¹, Ananya Sen²

Authors’ Affiliations:
¹ Inserm U1139, Faculté de Pharmacie de Paris, Université Paris Cité, Paris, France
² Department of Biophysics and Molecular Biology, University of Calcutta, Kolkata, India

Abstract:
Early-onset preeclampsia (< 34 weeks) and late-onset preeclampsia (≥ 34 weeks) present distinct placental phenotypes, requiring separate biomarker frameworks for early gestational tracking. This prospective longitudinal study explored the diagnostic utility of profiling circulating placental exosomal microRNAs (miRNAs) in the first trimester to predict specific preeclampsia subtypes. Plasma samples were collected from 520 asymptomatic singleton pregnancies between 11 and 13⁺⁶ weeks. Exosomes were isolated via ultracentrifugation, and miRNA expression levels were quantified using quantitative real-time polymerase chain reaction (qPCR). Patients were followed until delivery, with 28 developing early-onset and 42 developing late-onset preeclampsia. Differential expression analysis revealed that early-onset preeclampsia was independently characterized by a significant upregulation of exosomal miR-210 and miR-517a (p < 0.001). Conversely, late-onset preeclampsia demonstrated distinct elevations in miR-155 expressions (p = 0.004). A machine learning Random Forest model incorporating the first-trimester exosomal miRNA signatures alongside maternal mean arterial pressure achieved an Area Under the Curve (AUC) of 0.94 for predicting early-onset preeclampsia, yielding a sensitivity of 89.3% and a specificity of 92.1%. Its predictive power for late-onset disease was moderate (AUC = 0.81). Quantified shifts in first-trimester maternal plasma exosomal microRNA patterns provide a high-precision, non-invasive molecular index capable of differentiating preeclampsia phenotypes long before clinical signs manifest.

Keywords: Preeclampsia Subtypes; Exosomes; MicroRNA; Liquid Biopsy; First-Trimester Screening; Biomarkers.

Manuscript Timeline: Received: July 12, 2026; Revised: September 04, 2026; Accepted: September 16, 2026; Published: September 26, 2026.

Citation: Laurent C, Sen A. Predictive Modeling of Preeclampsia Subtypes Utilizing First-Trimester Circulating Exosomal MicroRNAs. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1059–1070.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1047–1058

DOI: 10.46882/2026/IJOG/000568

Original Research Article

Title: Efficacy of Robotic Apical Suspension versus Vaginal Native Tissue Repair for Advanced Uterine Prolapse

Names of Authors: Giuseppe Bianchi¹, Lin-Wei Chen²

Authors’ Affiliations:
¹ Department of Gynecology, University of Milan, Milan, Italy
² Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan

Abstract:
Advanced pelvic organ prolapse significantly compromises the structural quality of life in postmenopausal women. This prospective comparative study evaluated the 2-year anatomical durability and functional outcomes of Robotic Sacrocolpopexy (RSC) relative to Vaginal Native Tissue Repair (VNTR) via sacrospinous ligament fixation. One hundred and forty postmenopausal patients presenting with symptomatic Stage III or IV apical uterine prolapse were assigned to undergo either RSC (n = 70) or VNTR (n = 70). The primary endpoint measured was objective anatomical success, defined as Pelvic Organ Prolapse Quantification (POP-Q) stage 0 or I at the apical compartment 24 months post-surgery. At 2 years, RSC demonstrated a significantly higher objective success rate compared to the VNTR group (94.3% vs. 81.4%, p = 0.018). Subjective symptom scores on the Pelvic Floor Distress Inventory (PFDI-20) showed marked, equivalent improvements across both surgical branches (p < 0.001). However, the VNTR group experienced higher rates of anterior compartment recurrence requiring minor revision (14.3% vs. 2.9%, p = 0.022). Total operative duration was significantly longer in the robotic cohort (114.5 ± 22.4 minutes vs. 54.2 ± 12.8 minutes, p < 0.001), but it yielded lower rates of transient postoperative voiding dysfunction (p = 0.034). Robotic sacrocolpopexy provides superior long-term anatomical durability and a lower recurrence profile for advanced apical uterine prolapse compared to native vaginal tissue suspension despite longer initial operative timelines.

Keywords: Pelvic Organ Prolapse; Robotic Sacrocolpopexy; Native Tissue Repair; Apical Suspension; Recurrence Rate; Urogynecology.

Manuscript Timeline: Received: July 10, 2026; Revised: September 02, 2026; Accepted: September 14, 2026; Published: September 25, 2026.

Citation: Bianchi G, Chen LW. Efficacy of Robotic Apical Suspension versus Vaginal Native Tissue Repair for Advanced Uterine Prolapse. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1047–1058.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1035–1046

DOI: 10.46882/2026/IJOG/000567

Original Research Article

Title: Association between First-Trimester Maternal Serum Manganese Concentrations and the Subsequent Risk of Gestational Diabetes Mellitus

Names of Authors: Elizabeth Johnson¹, Greta Fischer²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
² Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

Abstract:
Manganese functions as an essential trace element cofactor for key metabolic enzymes involved in gluconeogenesis and antioxidant defenses, yet its relationship with maternal carbohydrate kinetics remains poorly defined. This prospective cohort study examined the relationship between early-pregnancy maternal serum manganese levels and the subsequent risk of developing Gestational Diabetes Mellitus (GDM). Serum samples were collected from 500 normotensive nulliparous women between 11 and 13⁺⁶ weeks of gestation, and absolute manganese concentrations were quantified via inductively coupled plasma mass spectrometry. All participants underwent standard 2-hour, 75 g oral glucose tolerance testing (OGTT) at 24 to 28 weeks to diagnose GDM. Sixty women (12.0%) developed GDM. First-trimester maternal serum manganese levels were significantly lower in the cohort that subsequently developed GDM compared to those who maintained normal metabolic profiles (1.12 ± 0.32 μg/L vs. 1.64 ± 0.45 μg/L, p < 0.001). Adjusting for baseline maternal age, body mass index, and family history of type 2 diabetes, multivariable logistic regression modeling confirmed that a first-trimester serum manganese level < 1.25 μg/L was associated with a threefold increase in the risk of GDM (Odds Ratio [OR] = 3.14; 95% CI, 1.62 to 6.08, p < 0.001). Early maternal serum manganese deficiency during the first trimester is independently associated with an elevated risk of subsequent gestational diabetes mellitus, highlighting a potential role for early micronutrient risk stratification.

Keywords: Gestational Diabetes Mellitus; Manganese Deficiency; Trace Elements; Insulin Resistance; First-Trimester Screening; Metabolic Biomarkers.

Manuscript Timeline: Received: July 08, 2026; Revised: September 04, 2026; Accepted: September 18, 2026; Published: September 29, 2026.

Citation: Johnson E, Fischer G. Association between First-Trimester Maternal Serum Manganese Concentrations and the Subsequent Risk of Gestational Diabetes Mellitus. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1035–1046.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1011–1022

DOI: 10.46882/2026/IJOG/000565

Original Research Article

Title: Predictive Accuracy of Mid-Trimester Serum Soluble Endoglin and Placental Growth Factor Ratio for Late-Onset Preeclampsia

Names of Authors: Olivia Taylor¹, Marie Dupont²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
² Service de Gynécologie-Obstétrique, Hôpital de la Conception, Marseille, France

Abstract:
Late-onset preeclampsia (developing at or after 34 weeks of gestation) presents unpredictable clinical courses, requiring robust biomarkers to optimize screening and management pathways. This prospective cohort study assessed the diagnostic performance of the mid-trimester serum soluble endoglin to placental growth factor (sEng/PlGF) ratio in predicting the subsequent development of late-onset preeclampsia. Serum samples were collected from 500 asymptomatic nulliparous women between 20 and 24 weeks of gestation during routine anatomical ultrasound scans. Biomarker levels were quantified via automated immunoassays. All participants were followed longitudinally until delivery, and 48 cases (9.6%) were complicated by late-onset preeclampsia. Women who subsequently developed the condition demonstrated significantly elevated sEng concentrations and decreased PlGF levels at mid-gestation, resulting in an elevated sEng/PlGF ratio compared to normotensive controls (42.4 ± 10.5 vs. 18.5 ± 5.2, p < 0.001). A multivariable predictive risk index incorporating maternal mean arterial pressure (MAP), uterine artery pulsatility index, and the sEng/PlGF ratio achieved an excellent diagnostic performance, yielding a sensitivity of 85.4%, a specificity of 89.2%, and an Area Under the Curve (AUC) of 0.92 for late-onset preeclampsia prediction. Mid-trimester screening utilizing maternal serum angiogenic biomarkers combined with clinical blood pressure indices provides an objective, highly reproducible risk matrix to identify women likely to experience late-onset preeclampsia long before clinical manifestations emerge.

Keywords: Late-Onset Preeclampsia; Soluble Endoglin; Placental Growth Factor; Angiogenic Biomarkers; Mid-Trimester Screening; Risk Stratification.

Manuscript Timeline: Received: July 02, 2026; Revised: August 28, 2026; Accepted: September 14, 2026; Published: September 24, 2026.

Citation: Taylor O, Dupont M. Predictive Accuracy of Mid-Trimester Serum Soluble Endoglin and Placental Growth Factor Ratio for Late-Onset Preeclampsia. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1011–1022.