International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 747–758

DOI: 10.4688 कार्र2026/IJOG/000543

Original Research Article

Title: Prophylactic Uterine Artery Embolization during Cesarean Delivery for Advanced Placenta Accreta Spectrum Disorders

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

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

Abstract:
Placenta Accreta Spectrum (PAS) disorders carry extreme risks of catastrophic intrapartum hemorrhage, frequently requiring emergency peripartum hysterectomies. This prospective cohort study evaluated the efficacy and safety of a hybrid surgical protocol combining prophylactic intraoperative Uterine Artery Embolization (UAE) immediately following fetal delivery during planned cesarean section for PAS. Sixty pregnant women diagnosed with high-grade PAS (increta or percreta) via magnetic resonance imaging were divided into two arms: the hybrid UAE group (prophylactic internal iliac artery balloon occlusion followed by gelatin sponge embolization; n = 30) and the standard surgical hemostasis control group (standard vascular ligation and resection; n = 30). The hybrid intervention significantly lowered the mean calculated intraoperative blood loss compared to standard surgery (1142.5 ± 250.4 mL vs. 2840.6 ± 680.2 mL, p < 0.001). The requirement for blood transfusions was reduced by 60.0% in the UAE cohort (p < 0.001). Crucially, the rate of successful uterine preservation (avoidance of peripartum hysterectomy) was significantly higher in the hybrid intervention arm (86.7% vs. 43.3%, p = 0.001). No severe ischemic complications or infectious secondary endometritis were noted up to 12 weeks postpartum. Prophylactic intraoperative uterine artery embolization during planned cesarean section represents a highly effective hemostatic technique that minimizes surgical blood loss and optimizes uterine preservation metrics in patients with advanced placenta accreta spectrum.

Keywords: Placenta Accreta Spectrum; Uterine Artery Embolization; Postpartum Hemorrhage; Hybrid Surgery; Peripartum Hysterectomy; Blood Transfusion.

Manuscript Timeline: Received: August 04, 2026; Revised: August 30, 2026; Accepted: September 10, 2026; Published: September 18, 2026.

Citation: Aliyu FB, Bakare TM. Prophylactic Uterine Artery Embolization during Cesarean Delivery for Advanced Placenta Accreta Spectrum Disorders. International Journal of Obstetrics and Gynecology. 2026; 14(9): 747–758.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 735–746

DOI: 10.46882/2026/IJOG/000542

Original Research Article

Title: A Randomized Controlled Trial of Intravaginal Dehydroepiandrosterone versus Estriol Gel for Genitourinary Syndrome of Menopause in Early 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) triggers progressive epithelial thinning and severe local mucosal dyspareunia. This randomized, double-blind active-controlled trial assessed the tissue-restoring efficacy, impact on vaginal pH, and circulating hormonal safety profile of once-daily intravaginal prasterone (dehydroepiandrosterone [DHEA], 6.5 mg) capsules versus local 0.1% estriol gel. One hundred and forty early postmenopausal women presenting with severe GSM symptoms were randomized into two equal cohorts (n = 70 per group) for a treatment course 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 daily application, both arms achieved equivalent, significant improvements in mean VHI scores (p < 0.001) and reduction of vaginal pH below 4.8 (p < 0.001). Subjective dyspareunia intensity dropped substantially in both the prasterone and estriol groups (mean reductions of 1.92 ± 0.45 and 1.88 ± 0.52 points, respectively, p = 0.74). Crucially, sequential blood monitoring confirmed that the prasterone cohort maintained stable, unchanged baseline serum estradiol and testosterone levels, whereas 11.4% of the estriol gel arm demonstrated transient systemic estriol elevations (p = 0.012). Daily intravaginal prasterone capsules offer mucosal tissue rejuvenation and symptomatic dyspareunia relief equivalent to local estriol gel, while avoiding any systemic sex-steroid accumulation.

Keywords: Genitourinary Syndrome of Menopause; Prasterone; Estriol Gel; Dyspareunia; Vaginal Health Index; Intracrinology.

Manuscript Timeline: Received: August 01, 2026; Revised: August 28, 2026; Accepted: September 08, 2026; Published: September 15, 2026.

Citation: Bello MT, Effiong GE. A Randomized Controlled Trial of Intravaginal Dehydroepiandrosterone versus Estriol Gel for Genitourinary Syndrome of Menopause in Early Postmenopausal Women. International Journal of Obstetrics and Gynecology. 2026; 14(9): 735–746.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 723–734

DOI: 10.46882/2026/IJOG/000541

Original Research Article

Title: Clinical Efficacy of Autologous Bone Marrow Mesenchymal Stem Cell Transplantation for Refractory Premature Ovarian Insufficiency

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:
Premature Ovarian Insufficiency (POI) causes hypergonadotropic hypogonadism, leading to permanent infertility in young women. This prospective case-control clinical trial investigated the therapeutic safety and endocrine efficacy of autologous Bone Marrow-derived Mesenchymal Stem Cell (BM-MSC) transplantation via localized intraovarian injection. Sixty women diagnosed with refractory POI (amenorrhea > 12 months, FSH > 40 IU/L) were enrolled; 30 patients underwent laparoscopic intraovarian microinjection of autologous BM-MSCs, while 30 age-matched POI patients on standard hormone replacement therapy served as controls. Serum AMH, FSH, and estradiol concentrations were evaluated monthly, alongside transvaginal ultrasound monitoring of Antral Follicle Counts (AFC). At 6 months post-treatment, 56.7% of the BM-MSC group demonstrated a clinical resumption of menstruation, compared to 0.0% of controls (p < 0.001). The treated group achieved a significant increase in median serum AMH levels (0.02 ng/mL to 0.14 ng/mL, p = 0.002) and a significant reduction in mean serum FSH levels (68.4 ± 12.5 IU/L to 28.5 ± 8.4 IU/L, p < 0.001). Ultrasound confirmed the reappearance of active antral follicles in 46.7% of treated ovaries, leading to three spontaneous, successful clinical pregnancies within the follow-up window. No severe procedural side effects or neoplastic transformations were identified. Autologous bone marrow mesenchymal stem cell transplantation successfully restores baseline ovarian endocrinological functions and rescues follicular growth paths in women experiencing premature ovarian insufficiency.

Keywords: Premature Ovarian Insufficiency; Mesenchymal Stem Cells; Stem Cell Transplantation; Ovarian Rejuvenation; Folliculogenesis; Anti-Müllerian Hormone.

Manuscript Timeline: Received: July 30, 2026; Revised: August 25, 2026; Accepted: September 06, 2026; Published: September 12, 2026.

Citation: Nwosu AP, Kudoyin ST. Clinical Efficacy of Autologous Bone Marrow Mesenchymal Stem Cell Transplantation for Refractory Premature Ovarian Insufficiency. International Journal of Obstetrics and Gynecology. 2026; 14(9): 723–734.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 711–722

DOI: 10.46882/2026/IJOG/000540

Original Research Article

Title: A Randomized Controlled Trial of Single-Port vNOTES versus Conventional Laparoscopy for Total Hysterectomy in Severe 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:
Executing minimally invasive total hystectomies in patients with advanced endometriosis is frequently complicated by dense pelvic adhesions, frozen pelvis characteristics, and altered anatomical planes. This prospective randomized clinical trial evaluated the surgical parameters, complication rates, and pain patterns of Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) against conventional multi-port Laparoscopy (CL) for hysterectomies in women with severe pelvic endometriosis. One hundred and twenty patients presenting with revised American Society for Reproductive Medicine (rASRM) stage IV endometriosis requiring total hysterectomy were randomized to either the vNOTES group (n = 60) or the CL group (n = 60). The primary outcome was total operative duration. The mean operative time was significantly shorter in the vNOTES cohort compared to the CL cohort (68.4 ± 14.5 minutes vs. 92.6 ± 18.2 minutes, p < 0.001), as direct access to the pouch of Douglas facilitated efficient dissection of posterior cul-de-sac obliterating lesions. Visual analog scale pain scores at 24 hours postoperatively were lower in the vNOTES group (1.8 ± 0.4 vs. 3.6 ± 1.1, p < 0.001), resulting in a 40.0% drop in ward opioid use. Incidence of accidental bladder or rectal injuries did not show structural divergence between the arms (p > 0.05). Total hysterectomy via vNOTES for stage IV pelvic endometriosis is an effective approach that shortens operational intervals and accelerates postoperative recovery timelines compared to conventional multi-port laparoscopy.

Keywords: vNOTES; Endometriosis; Total Hysterectomy; Pelvic Adhesions; Postoperative Pain; Minimally Invasive Surgery.

Manuscript Timeline: Received: July 28, 2026; Revised: August 22, 2026; Accepted: September 05, 2026; Published: September 10, 2026.

Citation: Cole OO, Chuka NC. A Randomized Controlled Trial of Single-Port vNOTES versus Conventional Laparoscopy for Total Hysterectomy in Severe Endometriosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 711–722.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 699–710

DOI: 10.46882/2026/IJOG/000539

Original Research Article

Title: Efficacy of Prophylactic Intravenous Calcium Gluconate for the Prevention of Severe Postpartum Hemorrhage during Vaginal Delivery

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:
Uterine atony remains the principal driver of postpartum hemorrhage (PPH). Calcium ions play an essential role in myometrial contractility, regulating the efficacy of endogenously produced or exogenously administered oxytocin. This double-blind, placebo-controlled randomized clinical trial investigated whether prophylactic intravenous calcium gluconate lowers intrapartum blood loss during vaginal deliveries in women at high risk for uterine atony. Three hundred and sixty women presenting with risk factors (prolonged labor, macrosomia, or polyhydramnios) were randomized to receive either 1 g of intravenous calcium gluconate (n = 180) or a matching 0.9% saline placebo (n = 180) slowly over 10 minutes concurrently with standard active management of the third stage of labor. The primary outcome was measured as the total calculated blood loss within 2 hours postpartum. The mean calculated blood loss was significantly reduced in the calcium gluconate group compared to the placebo cohort (342.5 ± 92.4 mL vs. 485.6 ± 124.8 mL, p < 0.001). The incidence of severe PPH (blood loss ≥ 1,000 mL) was lower in the intervention arm (1.7% vs. 6.1%, p = 0.028). Furthermore, the requirement for rescue second-line uterotonics (such as misoprostol or ergometrine) was significantly lower in the calcium arm (3.3% vs. 11.1%, p = 0.004). Prophylactic administration of calcium gluconate enhances myometrial baseline contractility and limits blood loss during high-risk vaginal deliveries without introducing adverse maternal hemodynamic alterations.

Keywords: Postpartum Hemorrhage; Calcium Gluconate; Uterine Atony; Vaginal Delivery; Myometrial Contractility; Uterotonics.

Manuscript Timeline: Received: July 25, 2026; Revised: August 20, 2026; Accepted: September 03, 2026; Published: September 07, 2026.

Citation: Adebayo OA, Yusuf AZ. Efficacy of Prophylactic Intravenous Calcium Gluconate for the Prevention of Severe Postpartum Hemorrhage during Vaginal Delivery. International Journal of Obstetrics and Gynecology. 2026; 14(9): 699–710.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 687–698

DOI: 10.46882/2026/IJOG/000538

Original Research Article

Title: Clinical Precision of Artificial Intelligence-Enhanced Cardiotocography Analysis in the Reduction of Intrapartum Neonatal Encephalopathy

Names of Authors: Chinedu O. Okafor¹, Fatima B. Aliyu²

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

Abstract:
Intrapartum fetal monitoring relies heavily on Cardiotocography (CTG), which is limited by substantial inter-observer variation and high false-positive rates for fetal distress. This prospective multi-center intervention trial evaluated the clinical utility of a real-time, artificial intelligence (AI)-driven automated CTG interpretation platform in lowering the rates of neonatal hypoxic-ischemic encephalopathy (HIE) and emergency operative deliveries. A cohort of 3,200 laboring women at term was assigned to either the AI-guided monitoring cohort (real-time automated alerts for abnormal patterns; n = 1,600) or the control cohort (standard clinical visual analysis; n = 1,600). The primary outcome measured was the incidence of confirmed neonatal HIE. Results demonstrated a significant reduction in the incidence of neonatal HIE in the AI-guided group compared to the control group (0.12% vs. 0.56%; Relative Risk [RR] = 0.21; 95% Confidence Interval [CI], 0.06 to 0.78; p = 0.012). Crucially, the rate of emergency cesarean deliveries performed for suspected fetal distress was significantly lower in the AI cohort (8.4% vs. 13.6%, p < 0.001), reflecting a drop in false-positive visual alerts. Mean neonatal umbilical artery pH at delivery was higher in the intervention arm (7.26 ± 0.04 vs. 7.21 ± 0.06, p = 0.004). Continuous AI-enhanced cardiotocography evaluation provides an objective decision-support layer during labor, significantly improving neonatal neurological safety margins while concurrently mitigating avoidable surgical interventions.

Keywords: Cardiotocography; Artificial Intelligence; Neonatal Encephalopathy; Intrapartum Monitoring; Fetal Distress; Cesarean Section.

Manuscript Timeline: Received: July 20, 2026; Revised: August 18, 2026; Accepted: September 02, 2026; Published: September 05, 2026.

Citation: Okafor CO, Aliyu FB. Clinical Precision of Artificial Intelligence-Enhanced Cardiotocography Analysis in the Reduction of Intrapartum Neonatal Encephalopathy. International Journal of Obstetrics and Gynecology. 2026; 14(9): 687–698.