International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 867–878

DOI: 10.46882/2026/IJOG/000553

Original Research Article

Title: Association between First-Trimester Maternal Serum Selenium Concentrations and the Subsequent Risk of Gestational Hypertension

Names of Authors: Bukola R. Omotayo¹, David C. Iwuala¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria

Abstract:
Selenium functions as an essential trace cofactor for glutathione peroxidase enzymes, playing a key role in mitigating systemic endothelial oxidative stress during vascular remodeling. This prospective cohort study investigated the relationship between early-pregnancy maternal serum selenium levels and the subsequent risk of developing gestational hypertension. Serum samples were collected from 600 normotensive nulliparous women between 11 and 13⁺⁶ weeks of gestation, and absolute selenium concentrations were quantified via inductively coupled plasma mass spectrometry. Participants were monitored longitudinally until delivery. Fifty-four women (9.0%) developed de novo gestational hypertension after 20 weeks. First-trimester maternal serum selenium levels were significantly lower in the cohort that subsequently developed gestational hypertension compared to those who remained normotensive (58.4 ± 12.2 μg/L vs. 78.6 ± 14.5 μg/L, p < 0.001). Adjusting for baseline maternal age, body mass index, and mean arterial pressure, multivariable logistic regression modeling confirmed that a first-trimester serum selenium level < 65 μg/L was associated with a threefold increase in the risk of gestational hypertension (Odds Ratio [OR] = 3.24; 95% CI, 1.64 to 6.42, p < 0.001). Early maternal serum selenium depletion in the first trimester is independently associated with an elevated risk of subsequent gestational hypertension, highlighting a potential role for early mineral antioxidant risk stratification.

Keywords: Gestational Hypertension; Selenium Deficiency; Trace Elements; Oxidative Stress; Endothelial Dysfunction; First-Trimester Screening.

Manuscript Timeline: Received: August 01, 2026; Revised: September 02, 2026; Accepted: September 12, 2026; Published: September 18, 2026.

Citation: Omotayo BR, Iwuala DC. Association between First-Trimester Maternal Serum Selenium Concentrations and the Subsequent Risk of Gestational Hypertension. International Journal of Obstetrics and Gynecology. 2026; 14(9): 867–878.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 843–854

DOI: 10.46882/2026/IJOG/000551

Original Research Article

Title: Evaluation of Single-Port vNOTES versus Conventional Laparoscopy for Myomectomy in Subserosal Leiomyomas

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:
Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) eliminates visible abdominal scar formation by using the vaginal pathway for endoscopic execution. This prospective randomized controlled trial compared the surgical parameters, postoperative pain intensity, and cosmetic satisfaction scores of single-port vNOTES myomectomy against conventional multi-port Laparoscopy (CL) for the excision of subserosal uterine leiomyomas. One hundred premenopausal women requiring surgical myomectomy for symptomatic subserosal fibroids (maximum diameter ≤ 8 cm) were randomized to either the vNOTES group (n = 50) or the CL group (n = 50). The primary endpoints evaluated included total operative duration, visual analog scale (VAS) pain scores at 12 and 24 hours post-surgery, and total analgesic consumption. The mean operative time was significantly shorter in the vNOTES cohort compared to the CL cohort (45.5 ± 12.2 minutes vs. 64.8 ± 15.4 minutes, p < 0.001). Postoperative VAS pain scores were lower in the vNOTES cohort at both 12 hours (1.8 ± 0.4 vs. 3.8 ± 1.1, p < 0.001) and 24 hours (1.1 ± 0.3 vs. 2.4 ± 0.6, p < 0.001), yielding a 40.0% reduction in postoperative ward opioid requirements. Cosmetic outcome scores evaluated 6 weeks post-surgery were significantly higher in the single-incision vaginal arm due to the absolute absence of abdominal scars (9.8 ± 0.2 vs. 7.4 ± 0.9, p < 0.001). Single-port vNOTES myomectomy for benign subserosal fibroids is a safe approach that minimizes operative durations, limits early postoperative pain, and avoids visible abdominal scarring compared to conventional multi-port laparoscopy.

Keywords: vNOTES; Myomectomy; Subserosal Fibroids; Laparoscopy; Postoperative Pain; Cosmetic Satisfaction.

Manuscript Timeline: Received: July 25, 2026; Revised: August 28, 2026; Accepted: September 06, 2026; Published: September 12, 2026.

Citation: Cole OO, Chuka NC. Evaluation of Single-Port vNOTES versus Conventional Laparoscopy for Myomectomy in Subserosal Leiomyomas. International Journal of Obstetrics and Gynecology. 2026; 14(9): 843–854.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 831–842

DOI: 10.46882/2026/IJOG/000550

Original Research Article

Title: Efficacy of Prophylactic Sublingual Misoprostol combined with Oxytocin versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Cesarean Birth for Multiple Pregnancies

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

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Multiple gestations induce profound uterine overdistension, predisposing women to severe uterine atony and postpartum hemorrhage (PPH) during cesarean deliveries. This double-blind randomized controlled trial compared the prophylactic efficacy and safety of a combination of sublingual misoprostol plus low-dose oxytocin against standard high-dose oxytocin infusion alone in multiple pregnancies. Two hundred pregnant women with twin or triplet gestations undergoing scheduled cesarean delivery under spinal anesthesia were randomized into two arms (n = 100 per group). The misoprostol group received 400 μg sublingual misoprostol immediately following skin incision plus a 5 IU intravenous oxytocin bolus after fetal extraction. The control group received a matching sublingual placebo and a standard 20 IU intravenous oxytocin infusion administered over 4 hours. The primary outcome was total perioperative blood loss. The mean perioperative blood loss was significantly lower in the misoprostol-oxytocin group compared to the control group (642.5 ± 150.4 mL vs. 885.6 ± 210.2 mL, p < 0.001). The primary PPH rate (blood loss ≥ 1,000 mL) was also lower in the combination cohort (4.0% vs. 14.0%, p = 0.021). Postpartum hemoglobin drops were significantly smaller in the misoprostol arm (0.82 ± 0.24 g/dL vs. 1.42 ± 0.38 g/dL, p < 0.001). Transient shivering (32.0% vs. 6.0%, p < 0.001) and low-grade pyrexia were more common in the misoprostol group. Prophylactic sublingual misoprostol combined with low-dose oxytocin provides superior hemostatic efficacy and minimizes perioperative blood loss during multiple-gestation cesarean births compared to standard oxytocin infusion alone.

Keywords: Multiple Pregnancy; Cesarean Section; Misoprostol; Oxytocin; Postpartum Hemorrhage; Uterine Atony.

Manuscript Timeline: Received: July 22, 2026; Revised: August 25, 2026; Accepted: September 05, 2026; Published: September 10, 2026.

Citation: Adebayo OA, Yusuf AZ. Efficacy of Prophylactic Sublingual Misoprostol combined with Oxytocin versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Cesarean Birth for Multiple Pregnancies. International Journal of Obstetrics and Gynecology. 2026; 14(9): 831–842.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 819–830

DOI: 10.46882/2026/IJOG/000549

Original Research Article

Title: A Randomized Controlled Trial of Intravaginal Estriol Gel versus Non-Hormonal Lubricant for Genitourinary Syndrome of Menopause in Postmenopausal Women

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:
Genitourinary Syndrome of Menopause (GSM) is characterized by progressive vulvovaginal mucosal atrophy, resulting in severe dyspareunia and vaginal dryness. This randomized, double-blind active-controlled trial assessed the tissue-restoring efficacy, changes in vaginal maturation index, and local safety of once-daily intravaginal 0.1% estriol gel compared to a non-hormonal polycarbophil-based vaginal lubricant. One hundred and forty postmenopausal women presenting with severe GSM symptoms were randomized into two equal cohorts (n = 70 per group) for a treatment period of 12 weeks. Primary outcomes included changes in the Vaginal Health Index (VHI) score, vaginal pH, and subjective symptom severity scores. After 12 weeks of treatment, the estriol gel cohort achieved a significantly higher mean VHI score compared to the lubricant cohort (21.5 ± 2.2 vs. 14.8 ± 1.6, p < 0.001). Mean vaginal pH dropped significantly below 4.5 in the estriol arm, whereas it remained elevated above 5.5 in the lubricant arm (p < 0.001). Subjective dyspareunia intensity dropped substantially more in the estriol group than in the lubricant group (mean reductions of 2.15 ± 0.45 vs. 0.85 ± 0.22 points, p < 0.001). Circulating hormonal monitoring confirmed that serum estradiol levels remained well within the safe postmenopausal baseline threshold (< 10 pg/mL) in both groups. Daily intravaginal estriol gel offers significantly superior mucosal tissue rejuvenation and symptomatic dyspareunia relief compared to non-hormonal lubricants without causing systemic estrogenic accumulation.

Keywords: Genitourinary Syndrome of Menopause; Estriol Gel; Vaginal Lubricant; Dyspareunia; Vaginal Health Index; Postmenopausal Health.

Manuscript Timeline: Received: July 18, 2026; Revised: August 22, 2026; Accepted: September 03, 2026; Published: September 07, 2026.

Citation: Bello MT, Effiong GE. A Randomized Controlled Trial of Intravaginal Estriol Gel versus Non-Hormonal Lubricant for Genitourinary Syndrome of Menopause in Postmenopausal Women. International Journal of Obstetrics and Gynecology. 2026; 14(9): 819–830.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 795–806

DOI: 10.46882/2026/IJOG/000547

Original Research Article

Title: A Randomized Controlled Trial of Double-Lumen versus Single-Lumen Needles for Oocyte Retrieval in Advanced Maternal Age Patients

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 retrieval in patients of advanced maternal age requires technical strategies that maximize oocyte yields from a limited number of follicles. This prospective randomized clinical trial evaluated the efficacy, aspiration duration, and pelvic pain profiles of a double-lumen follicle aspiration needle enabling immediate flushing versus a standard single-lumen aspiration needle. One hundred subfertile women aged 38 to 43 years 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 collection. The primary endpoint evaluated was the total number of mature (Metaphase II) oocytes retrieved per patient. The mean number of mature oocytes retrieved was statistically identical between the double-lumen and single-lumen arms (3.4 ± 1.2 vs. 3.2 ± 1.4, p = 0.45). The fertilization and blastocyst development rates 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 the repeated flushing phases (18.4 ± 4.2 minutes vs. 10.5 ± 2.4 minutes, p < 0.001). Postoperative pelvic pain scores checked via a visual analog scale were significantly higher in the double-lumen arm (p = 0.008). In advanced maternal age patients with diminished reserves, a double-lumen needle with follicular flushing does not increase mature oocyte yields but prolongs operative timelines and increases postoperative pelvic discomfort.

Keywords: Advanced Maternal Age; Oocyte Retrieval; Follicular Flushing; Double-Lumen Needle; Single-Lumen Needle; IVF Yields.

Manuscript Timeline: Received: August 15, 2026; Revised: September 06, 2026; Accepted: September 16, 2026; Published: September 30, 2026.

Citation: Nuosu AP, Kudoyin ST. A Randomized Controlled Trial of Double-Lumen versus Single-Lumen Needles for Oocyte Retrieval in Advanced Maternal Age Patients. International Journal of Obstetrics and Gynecology. 2026; 14(9): 795–806.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 771–782

DOI: 10.46882/2026/IJOG/000545

Original Research Article

Title: Efficacy of Prophylactic Intravenous Ondansetron for the Prevention of Sympathetic Blockade-Induced Hypotension during Cesarean Section under Spinal Anesthesia

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:
Spinal anesthesia for cesarean delivery routinely induces maternal hypotension and shivering secondary to sympathetic blockade and the Bezold-Jarisch reflex. This double-blind randomized clinical trial investigated the hemostatic efficacy of prophylactic intravenous ondansetron in stabilizing cardiovascular parameters and reducing vasopressor needs. Two hundred healthy women scheduled for elective cesarean delivery were randomized to receive either 4 mg of intravenous ondansetron (n = 100) or a matching saline placebo (n = 100) 5 minutes before the initiation of spinal anesthesia. Vital signs were checked at 2-minute intervals during the first 20 minutes following spinal block. The primary endpoint was the incidence of maternal hypotension (systolic blood pressure < 90 mmHg). The incidence of spinal anesthesia-induced maternal hypotension was significantly lower in the ondansetron group compared to the placebo group (28.0% vs. 52.0%, p = 0.001). Consequently, the mean dose of rescue phenylephrine required to restore baseline blood pressure was significantly lower in the ondansetron arm (1.2 ± 0.4 mg vs. 2.5 ± 0.8 mg, p < 0.001). Ondansetron also reduced the severity of intraoperative nausea and vomiting (4.0% vs. 16.0%, p = 0.004). Neonatal outcomes measured via umbilical artery gas parameters and 5-minute Apgar scores were excellent and equal across both arms (p > 0.05). Prophylactic administration of 4 mg intravenous ondansetron effectively minimizes sympathetic blockade-induced hypotension and limits overall vasopressor dependencies during cesarean sections under spinal anesthesia.

Keywords: Spinal Anesthesia; Cesarean Section; Hypotension; Ondansetron; Phenylephrine; Bezold-Jarisch Reflex.

Manuscript Timeline: Received: August 10, 2026; Revised: September 04, 2026; Accepted: September 14, 2026; Published: September 25, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. Efficacy of Prophylactic Intravenous Ondansetron for the Prevention of Sympathetic Blockade-Induced Hypotension during Cesarean Section under Spinal Anesthesia. International Journal of Obstetrics and Gynecology. 2026; 14(9): 771–782.