International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 939–950

DOI: 10.46882/2026/IJOG/000559

Original Research Article

Title: Predictive Precision of First-Trimester Cell-Free RNA Expression Profiles for Spontaneous Preterm Birth Risk Stratification

Names of Authors: Sarah L. Jenkins¹, Hiroshi Tanaka²

Authors’ Affiliations:
¹ Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
² Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan

Abstract:
Early identification of asymptomatic women predisposed to spontaneous preterm birth (sPTB) remains an unmet challenge in maternal-fetal surveillance. This prospective observational cohort study investigated the predictive accuracy of utilizing first-trimester maternal plasma cell-free RNA (cfRNA) transcriptomic profiles to forecast spontaneous delivery prior to 34 weeks of gestation. Blood samples were collected from 650 nulliparous singleton pregnancies between 11 and 13⁺⁶ weeks. High-throughput total cell-free RNA sequencing mapped circulating fetal and placental transcript boundaries. All participants were followed longitudinally until delivery, where 58 cases (8.9%) were complicated by spontaneous preterm birth before 34 weeks. Differential expression analysis revealed a distinct, early transcriptomic signature in women who subsequently delivered preterm. A panel of four specific placenta-associated transcripts (PSG9, CRH, CGB3, and PLAC4) demonstrated significant upregulation at early gestation (p < 0.001). A machine learning classification model utilizing this 4-gene cfRNA profile achieved an exceptional predictive performance, yielding a sensitivity of 86.2%, a specificity of 91.2%, and an Area Under the Curve (AUC) of 0.93. This liquid biopsy molecular index significantly outperformed standard screening models based on maternal risk history and transvaginal cervical length (p < 0.001). Tracking first-trimester maternal plasma cell-free RNA signatures provides a non-invasive screening platform capable of tracking subclinical placental senescence markers to predict spontaneous preterm birth.

Keywords: Spontaneous Preterm Birth; Cell-Free RNA; Transcriptomics; Liquid Biopsy; Placental Senescence; Early Screening.

Manuscript Timeline: Received: June 18, 2026; Revised: August 12, 2026; Accepted: September 04, 2026; Published: September 07, 2026.

Citation: Jenkins SL, Tanaka H. Predictive Precision of First-Trimester Cell-Free RNA Expression Profiles for Spontaneous Preterm Birth Risk Stratification. International Journal of Obstetrics and Gynecology. 2026; 14(9): 939–950.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 927–938

DOI: 10.46882/2026/IJOG/000558

Original Research Article

Title: Clinical Efficacy of Robot-Assisted Laparoscopic Myomectomy versus Conventional Laparoscopic Myomectomy for Large Intramural Fibroids

Names of Authors: Elena R. Vasilyeva¹, Hans-Dieter Schmidt²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
² Division of Gynecological Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany

Abstract:
Laparoscopic excision of large intramural leiomyomas can be technically restricted by instrument triangulation barriers and complex multi-layered uterine reconstruction requirements. This prospective multi-center randomized trial compared the perioperative surgical outcomes, multi-layer suturing quality, and 1-year scar integrity of Robot-Assisted Laparoscopic Myomectomy (RALM) against Conventional Laparoscopic Myomectomy (CLM). A cohort of 160 premenopausal women presenting with 1 to 3 symptomatic intramural fibroids (dominant lesion diameter 7 to 10 cm) was randomized into two equal groups (n = 80 per group). The primary endpoints evaluated were total suturing time for myometrial defects and total intraoperative blood loss. The mean myometrial suturing duration was significantly shorter in the RALM group compared to the CLM cohort (14.5 ± 3.2 minutes vs. 24.8 ± 5.6 minutes, p < 0.001), facilitated by articulated robotic instrumentation. Consequently, the mean total intraoperative blood loss was significantly lower in the robotic arm (112.4 ± 35.8 mL vs. 185.6 ± 52.4 mL, p < 0.001). Postoperative visual analog scale pain scores at 24 hours were lower in the RALM cohort (p = 0.012). Transvaginal ultrasound evaluation at month 12 revealed zero cases of sub-optimal uterine wall healing or persistent hematomas in either arm. Robot-assisted laparoscopic myomectomy for large intramural fibroids significantly lowers operative blood loss and accelerates myometrial reconstruction timelines compared to conventional laparoscopy due to enhanced rotational dexterity.

Keywords: Robotic Myomectomy; Laparoscopy; Uterine Fibroids; Intramural Leiomyoma; Myometrial Suturing; Operative Blood Loss.

Manuscript Timeline: Received: June 15, 2026; Revised: August 10, 2026; Accepted: September 02, 2026; Published: September 05, 2026.

Citation: Vasilyeva ER, Schmidt HD. Clinical Efficacy of Robot-Assisted Laparoscopic Myomectomy versus Conventional Laparoscopic Myomectomy for Large Intramural Fibroids. International Journal of Obstetrics and Gynecology. 2026; 14(9): 927–938.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 915–926

DOI: 10.46882/2026/IJOG/000557

Original Research Article

Title: Efficacy of Prophylactic Bakri Balloon Tamponade during Cesarean Delivery for Placenta Previa in Singleton Term Pregnancies

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 carries a high baseline risk of severe intraoperative 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 stable, complete placenta previa. One hundred and twenty pregnant women undergoing scheduled cesarean sections for 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 calculated perioperative blood loss. The mean total intraoperative and postoperative blood loss was significantly lower in the Bakri balloon group compared to the conventional control group (645.2 ± 180.4 mL vs. 985.6 ± 290.2 mL, p < 0.001). The requirement for emergency secondary surgical interventions, such as uterine artery ligation or B-Lynch compressed sutures, was significantly reduced in the balloon cohort (1.7% vs. 11.7%, p = 0.028). Packed red blood cell transfusion requirements were also significantly decreased in the prophylactic intervention arm (5.0% vs. 18.3%, p = 0.024). There were no cases of secondary balloon displacement, uterine rupture, or post-procedural endometritis in the intervention group. Prophylactic placement of the Bakri balloon tamponade during cesarean sections for complete placenta previa is a safe strategy that effectively limits perioperative blood loss and prevents additional surgical hemostatic interventions.

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

Manuscript Timeline: Received: August 10, 2026; Revised: September 08, 2026; Accepted: September 18, 2026; Published: September 28, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. Efficacy of Prophylactic Bakri Balloon Tamponade during Cesarean Delivery for Placenta Previa in Singleton Term Pregnancies. International Journal of Obstetrics and Gynecology. 2026; 14(9): 915–926.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 903–914

DOI: 10.46882/2026/IJOG/000556

Original Research Article

Title: A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Stage III Peritoneal Endometriosis

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:
Pelvic endometriosis causes chronic severe pelvic pain and dysmenorrhea, requiring precise targeted destruction of lesions. This randomized, open-label clinical trial compared the 1-year therapeutic efficacy, improvements in quality of life scores, and complications of non-invasive ultrasound-guided High-Intensity Focused Ultrasound (HIFU) thermal ablation against standard Laparoscopic Ablation/Excision (LA) for symptomatic stage III peritoneal endometriosis. One hundred premenopausal women with laparndoscopically or MRI-confirmed stage III pelvic endometriosis presenting with severe refractory pain were randomized into two equal treatment arms (n = 50 per group). The primary outcomes checked at 12 months were reductions in pain visual analog scale (VAS) scores and updates on the Endometriosis Health Profile (EHP-30) questionnaire. At 12 months post-intervention, both groups demonstrated a substantial reduction in mean chronic pelvic pain VAS scores from baseline (p < 0.001), with no significant difference between the two cohorts (HIFU: -4.2 ± 1.1 points; LA: -4.5 ± 1.3 points, p = 0.18). Quality of life indexes on the EHP-30 improved equivalently across both arms (p = 0.24). However, the HIFU cohort experienced significantly shorter operational recovery timelines, with a median length of hospital stay of 6 hours compared to 48 hours for the open surgical LA group (p < 0.001). Major procedural complications were absent in the HIFU group but occurred in 6.0% of the laparoscopic group (p = 0.041). Non-invasive HIFU thermal ablation offers chronic pain relief and quality of life improvements equivalent to laparoscopic surgery for stage III peritoneal endometriosis while achieving significantly shorter hospital stay requirements.

Keywords: Peritoneal Endometriosis; High-Intensity Focused Ultrasound; Laparoscopic Ablation; Chronic Pelvic Pain; Quality of Life; Thermal Destruction.

Manuscript Timeline: Received: August 08, 2026; Revised: September 06, 2026; Accepted: September 16, 2026; Published: September 26, 2026.

Citation: Cole OO, Chuka NC. A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Stage III Peritoneal Endometriosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 903–914.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 879–890

DOI: 10.46882/2026/IJOG/000554

Original Research Article

Title: A Randomized Controlled Trial of Double-Lumen versus Single-Lumen Needles for Oocyte Retrieval in Patients with Endometrioma

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:
Oocyte collection in women presenting with ovarian endometriomas requires maximum technical optimization to retrieve competent oocytes without puncturing adjacent chocolate cysts, which carry risks of pelvic infection. This randomized clinical trial compared the efficacy, aspiration duration, and pelvic contamination profiles of a double-lumen follicle aspiration needle enabling immediate flushing versus a standard single-lumen aspiration needle. One hundred subfertile women with unilateral or bilateral ovarian endometriomas (diameter 3 to 5 cm) undergoing controlled ovarian hyperstimulation for IVF were randomized to either the double-lumen needle group (n = 50) or the single-lumen needle group (n = 50) during transvaginal ultrasound-guided oocyte retrieval. The primary endpoint evaluated was the total number of oocytes retrieved from ovaries containing endometriomas. The mean number of retrieved oocytes was statistically identical between the double-lumen and single-lumen arms (3.2 ± 1.1 vs. 3.0 ± 1.2, p = 0.44). The fertilization rates and high-grade blastocyst transformation metrics did not vary significantly between the cohorts (p > 0.05). However, the mean operative duration was significantly longer in the double-lumen needle group due to repetitive flushing steps (16.4 ± 3.5 minutes vs. 9.2 ± 2.1 minutes, p < 0.001). Postoperative pelvic infection or accidental endometrioma rupture did not occur in either group. In women with ovarian endometriomas, a double-lumen needle with follicular flushing does not increase total oocyte yield but significantly prolongs surgical timelines compared to a single-lumen needle.

Keywords: Ovarian Endometrioma; Oocyte Retrieval; Follicular Flushing; Double-Lumen Needle; Single-Lumen Needle; IVF Yields.

Manuscript Timeline: Received: August 04, 2026; Revised: September 04, 2026; Accepted: September 14, 2026; Published: September 20, 2026.

Citation: Nwosu AP, Kudoyin ST. A Randomized Controlled Trial of Double-Lumen versus Single-Lumen Needles for Oocyte Retrieval in Patients with Endometrioma. International Journal of Obstetrics and Gynecology. 2026; 14(9): 879–890.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 891–902

DOI: 10.46882/2026/IJOG/000555

Original Research Article

Title: Clinical Efficacy of Single-Dose Intravenous Ferric Carboxymaltose versus Oral Ferrous Fumarate for Iron Deficiency Anemia in the Second Trimester

Names of Authors: Chidi E. Eze¹, Aisha M. Umar²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
² Department of Obstetrics and Gynecology, Federal Medical Centre, Katsina, Nigeria

Abstract:
Maternal Iron Deficiency Anemia (IDA) during the second trimester is strongly linked with restricted fetal growth patterns and an elevated risk of preterm birth. This open-label, randomized controlled trial compared the clinical efficacy, hematological response velocity, and gastrointestinal safety of a single total-dose infusion of intravenous (IV) ferric carboxymaltose against standard oral ferrous fumarate therapy. Two hundred and forty pregnant women in their second trimester (20 to 24 weeks of gestation) presenting with a baseline hemoglobin (Hb) between 8.0 and 9.5 g/dL and serum ferritin < 12 μg/L were randomized into two equal groups (n = 120 per group). The IV group received a single 1,000 mg infusion of ferric carboxymaltose, while the oral group received oral ferrous fumarate (200 mg) twice daily for a duration of six weeks. The primary outcome was the mean increase in Hb levels from baseline to delivery. At the 4-week post-treatment evaluation, the mean Hb increase was significantly higher in the IV group compared to the oral group (2.25 ± 0.45 g/dL vs. 1.15 ± 0.32 g/dL, p < 0.001). Target Hb levels (≥ 11.0 g/dL) at delivery were achieved by 92.5% of women in the IV group compared to 64.2% in the oral group (p < 0.001). Serum ferritin stores were significantly more restored in the IV cohort (median 114.2 μg/L vs. 22.5 μg/L, p < 0.001). Gastrointestinal adverse effects occurred in 42.5% of the oral cohort, leading to non-compliance in 16.7% of cases. A single total-dose infusion of ferric carboxymaltose in the second trimester provides superior hematological correction and iron reserve restoration with excellent compliance and safety compared to oral iron.

Keywords: Iron Deficiency Anemia; Ferric Carboxymaltose; Ferrous Fumarate; Hemoglobin; Ferritin; Second Trimester.

Manuscript Timeline: Received: August 06, 2026; Revised: September 05, 2026; Accepted: September 15, 2026; Published: September 24, 2026.

Citation: Eze CE, Umar AM. Clinical Efficacy of Single-Dose Intravenous Ferric Carboxymaltose versus Oral Ferrous Fumarate for Iron Deficiency Anemia in the Second Trimester. International Journal of Obstetrics and Gynecology. 2026; 14(9): 891–902.