International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 543–554

DOI: 10.46882/2026/IJOG/000526

Original Research Article

Title: A Randomized Controlled Trial of Laparoscopic Ovarian Diathermy versus Aromatase Inhibitors for Clomiphene-Resistant Polycystic Ovary Syndrome

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:
Clomiphene citrate resistance complicates ovulation induction algorithms in women with Polycystic Ovary Syndrome (PCOS). This prospective randomized active-controlled trial compared the clinical efficacy, baseline endocrine changes, and cumulative live birth rates of Laparoscopic Ovarian Diathermy (LOD) against oral letrozole therapy. One hundred infertile women meeting the Rotterdam criteria for PCOS with confirmed clomiphene resistance were randomized into two equal groups (n = 50 per group). The LOD cohort underwent surgical puncture with a unipolar electrocautery needle, while the letrozole cohort received oral letrozole (2.5 mg daily for 5 days, up to six consecutive cycles). The primary outcome evaluated was the cumulative ovulation rate per group over a 6-month follow-up window. Spontaneous ovulation was achieved in 72.0% of women in the LOD group and 78.0% of the letrozole group, demonstrating no statistically significant variation between the interventions (p = 0.48). Mean serum anti-Müllerian hormone (AMH) levels dropped significantly from baseline in both groups (p < 0.001). The 6-month cumulative clinical pregnancy rates were 44.0% for LOD and 48.0% for letrozole (p = 0.69), while cumulative live birth rates were 38.0% and 42.0%, respectively (p = 0.68). The incidence of multiple pregnancies was 0.0% in both arms. Letrozole therapy provides ovulation induction outcomes and live birth rates equivalent to laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovary syndrome, offering an efficient, non-invasive first-line alternative to surgical interventions.

Keywords: Polycystic Ovary Syndrome; Letrozole; Laparoscopic Ovarian Diathermy; Clomiphene Resistance; Ovulation Induction; Live Birth Rate.

Manuscript Timeline: Received: June 10, 2026; Revised: July 28, 2026; Accepted: August 08, 2026; Published: August 31, 2026.

Citation: Nwosu AP, Kudoyin ST. A Randomized Controlled Trial of Laparoscopic Ovarian Diathermy versus Aromatase Inhibitors for Clomiphene-Resistant Polycystic Ovary Syndrome. International Journal of Obstetrics and Gynecology. 2026; 14(8): 543–554.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 555–566

DOI: 10.46882/2026/IJOG/000527

Original Research Article

Title: Efficacy of Prophylactic Intravenous Magnesium Sulfate Tapering versus Continuous Infusion for Eclampsia Prevention in Severe Preeclampsia

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:
Standard continuous 24-hour postpartum infusions of magnesium sulfate (MgSO₄) can contribute to maternal drug toxicity, motor weakness, and high nursing care burdens. This randomized controlled non-inferiority trial evaluated whether a shortened, prophylactic 12-hour intravenous MgSO₄ tapering regimen offers equivalent protection against eclamptic seizures compared to the traditional 24-hour continuous protocol in women with severe preeclampsia. Two hundred and sixty parturients diagnosed with severe preeclampsia were randomized to either the abbreviated 12-hour tapering group (n = 130) or the standard 24-hour group (n = 130) following a uniform 4 g loading dose. The primary endpoint was the development of eclamptic convulsions within 48 hours postpartum. No cases of eclampsia occurred in either the 12-hour or the 24-hour cohort (0.0% vs. 0.0%, p = 1.00), satisfying the pre-specified non-inferiority margin. Signs of mild magnesium toxicity, such as absent deep tendon reflexes or respiratory depression, were significantly lower in the abbreviated tapering arm (1.5% vs. 7.7%, p = 0.018). Furthermore, the mean time to unassisted maternal mobilization was significantly shorter in the 12-hour group (14.2 ± 2.4 hours vs. 26.5 ± 4.2 hours, p < 0.001), accelerating transition to newborn care. A shortened 12-hour postpartum magnesium sulfate tapering regimen is non-inferior to the standard 24-hour continuous infusion for eclampsia prevention in severe preeclampsia while significantly minimizing drug toxicity risks and improving early maternal recovery timelines.

Keywords: Severe Preeclampsia; Magnesium Sulfate; Eclampsia Prevention; Drug Toxicity; Postpartum Care; Shortened Regimen.

Manuscript Timeline: Received: June 12, 2026; Revised: July 30, 2026; Accepted: August 10, 2026; Published: August 31, 2026.

Citation: Sanusi IK, Nwachukwu CJ. Efficacy of Prophylactic Intravenous Magnesium Sulfate Tapering versus Continuous Infusion for Eclampsia Prevention in Severe Preeclampsia. International Journal of Obstetrics and Gynecology. 2026; 14(8): 555–566.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 531–542

DOI: 10.46882/2026/IJOG/000525

Original Research Article

Title: Evaluation of Salivary Estriol Dynamics and Cervicovaginal Oncofetal Fibronectin for the Prediction of Impending Preterm Labor

Names of Authors: Oluwaseun A. Adebayo¹, Chinedu O. Okafor², Aminat Z. Yusuf¹

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

Abstract:
Early identification of true preterm labor among symptomatic women remains vital to avoid unnecessary hospitalizations and target prophylactic glucocorticoid therapy. This prospective multi-center diagnostic accuracy study evaluated the predictive value of combining longitudinal salivary estriol monitoring with a point-of-care cervicovaginal fetal fibronectin (fFN) test in women presenting with threatened preterm labor. A cohort of 180 symptomatic singleton pregnancies between 24 and 34 weeks of gestation was enrolled. Salivary samples were analyzed using enzyme immunoassay, and a positive fFN threshold was set at ≥ 50 ng/mL. The primary clinical outcome was spontaneous delivery within 7 days of initial presentation. True preterm delivery within 7 days occurred in 22 participants (12.2%). Salivary estriol levels above a baseline threshold of 2.1 ng/mL coupled with a positive fFN test demonstrated an exceptional diagnostic performance, yielding a sensitivity of 90.9%, a specificity of 94.3%, a positive predictive value of 69.0%, and a negative predictive value of 98.7%. The Area Under the Curve (AUC) for the combined biomarkers was 0.95, significantly outperforming individual fFN testing (AUC = 0.81, p = 0.006) or standalone digital cervical assessment. In conclusion, integrating salivary estriol dynamics with cervicovaginal fetal fibronectin metrics provides a highly reliable, non-invasive diagnostic framework to predict imminent preterm delivery within a 7-day window, optimizing maternal transport and therapeutic triage.

Keywords: Preterm Labor; Fetal Fibronectin; Salivary Estriol; Diagnostic Accuracy; Premature Birth; Biomarkers.

Manuscript Timeline: Received: June 08, 2026; Revised: July 25, 2026; Accepted: August 06, 2026; Published: August 30, 2026.

Citation: Adebayo OA, Okafor CO, Yusuf AZ. Evaluation of Salivary Estriol Dynamics and Cervicovaginal Oncofetal Fibronectin for the Prediction of Impending Preterm Labor. International Journal of Obstetrics and Gynecology. 2026; 14(8): 531–542.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 519–530

DOI: 10.46882/2026/IJOG/000524

Original Research Article

Title: Evaluation of Letrozole versus Clomiphene Citrate for Ovulation Induction in Anovulatory Patients with Hypogonadotropic Hypogonadism

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:
While aromatase inhibitors are widely accepted as a first-line ovulation induction choice in polycystic ovary syndrome, comparative evaluations in patients presenting with WHO Group I anovulation remain sparse. This prospective randomized clinical trial evaluated the ovulation, endometrial thickness, and clinical pregnancy rates achieved by letrozole versus clomiphene citrate (CC) in women with idiopathic hypogonadotropic hypogonadism. Eighy infertile anovulatory women with confirmed low baseline gonadotropins and estradiol were randomized to receive either letrozole (5 mg daily for 5 days, n = 40) or CC (100 mg daily for 5 days, n = 40) for up to three consecutive treatment cycles. Human chorionic gonadotropin was administered when a dominant follicle reached ≥ 18 mm. Spontaneous ovulation occurred in 55.0% of letrozole-treated cycles compared to 52.5% of CC-treated cycles, showing no significant difference between the arms (p = 0.68). However, the mean endometrial thickness on the day of hCG administration was significantly greater in the letrozole cohort (8.8 ± 0.6 mm vs. 7.1 ± 0.8 mm, p < 0.001), secondary to the avoidance of anti-estrogenic mucosal depletion. Consequently, the cumulative clinical pregnancy rate was significantly higher in the letrozole group compared to the clomiphene citrate group (37.5% vs. 17.5%, p = 0.043). Letrozole provides ovulation rates equivalent to clomiphene citrate in hypogonadotropic hypogonadism but achieves significantly better endometrial proliferation and superior pregnancy outcomes.

Keywords: Ovulation Induction; Letrozole; Clomiphene Citrate; Hypogonadotropic Hypogonadism; Endometrial Thickness; Clinical Pregnancy Rate.

Manuscript Timeline: Received: June 05, 2026; Revised: July 22, 2026; Accepted: August 05, 2026; Published: August 29, 2026.

Citation: Nwosu AP, Kudoyin ST. Evaluation of Letrozole versus Clomiphene Citrate for Ovulation Induction in Anovulatory Patients with Hypogonadotropic Hypogonadism. International Journal of Obstetrics and Gynecology. 2026; 14(8): 519–530.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 507–518

DOI: 10.46882/2026/IJOG/000523

Original Research Article

Title: A Randomized Controlled Trial of Laparoscopic Pectopexy versus Sacrocolpopexy for Apical Pelvic Organ Prolapse

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:
Laparoscopic Sacrocolpopexy (LSC) is the gold standard for apical prolapse repair but can be technically challenging and carries specific risks of bowel interference near the sacral promontory. This randomized controlled trial compared the 2-year anatomical success rates, operative details, and complication profiles of Laparoscopic Pectopexy (LPC)—suspending the vaginal vault to the iliopectineal ligaments—against conventional LSC. One hundred women presenting with symptomatic POP-Q Stage III or IV uterine or vault prolapse were randomized into two equal groups (n = 50 per group). The primary outcome was apical compartment anatomical success (Stage 0 or I) at 24 months. At the 2-year follow-up, anatomical success was achieved in 94.0% of the LPC group and 92.0% of the LSC group, demonstrating therapeutic equivalence (p = 0.68). The mean operative time was significantly shorter in the pectopexy group due to easier suture access (78.4 ± 14.5 minutes vs. 104.6 ± 22.1 minutes, p < 0.001). Furthermore, the incidence of de novo defecation disorders (constipation) was significantly lower in the LPC cohort compared to the LSC cohort (2.0% vs. 14.0%, p = 0.027), secondary to total avoidance of the presacral space. Rates of mesh exposure or dyspareunia did not show structural divergence between the arms (p > 0.05). Laparoscopic pectopexy offers structural durability equivalent to sacrocolpopexy for advanced apical prolapse while reducing operative duration and minimizing postoperative defecation complications.

Keywords: Pelvic Organ Prolapse; Laparoscopic Pectopexy; Sacrocolpopexy; Iliopectineal Ligament; Postoperative Constipation; Apical Suspension.

Manuscript Timeline: Received: June 04, 2026; Revised: July 20, 2026; Accepted: August 04, 2026; Published: August 26, 2026.

Citation: Eze CE, Umar AM. A Randomized Controlled Trial of Laparoscopic Pectopexy versus Sacrocolpopexy for Apical Pelvic Organ Prolapse. International Journal of Obstetrics and Gynecology. 2026; 14(8): 507–518.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 495–506

DOI: 10.46882/2026/IJOG/000522

Original Research Article

Title: Association between Maternal Periodontal Disease and Spontaneous Preterm Birth Risk: A Prospective Cohort Study

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:
Chronic systemic inflammatory conditions are increasingly implicated in triggering premature labor pathways. This prospective cohort study evaluated the relationship between maternal periodontal disease diagnosed during early pregnancy and the incidence of spontaneous preterm birth (sPTB) before 37 completed weeks of gestation. Four hundred and fifty pregnant women undergoing routine prenatal care were enrolled between 12 and 16 weeks and underwent comprehensive periodontal examinations. Periodontal disease was classified according to clinical attachment loss and bleeding on probing. Participants were followed up until delivery, tracking the incidence of sPTB. Periodontal disease was diagnosed in 135 women (30.0%). The incidence of sPTB before 37 weeks was significantly higher in women with periodontal disease compared to those with healthy periodontal status (16.3% vs. 6.7%; Relative Risk [RR] = 2.43; 95% CI, 1.34 to 4.41; p = 0.003). The rate of early preterm delivery (< 34 weeks) was also elevated in the periodontal disease group (5.9% vs. 1.6%, p = 0.012). Adjusting for maternal age, socioeconomic background, smoking, and prior history of preterm birth, multivariable logistic regression confirmed that maternal periodontal disease remained an independent risk factor for spontaneous preterm birth (Odds Ratio = 2.65, 95% CI, 1.42 to 4.96). Active maternal periodontal disease in early pregnancy correlates with an elevated risk of spontaneous preterm birth, indicating a potential benefit for early oral screening during routine prenatal care.

Keywords: Spontaneous Preterm Birth; Periodontal Disease; Systemic Inflammation; Prenatal Care; Risk Factors; Gestational Age.

Manuscript Timeline: Received: June 01, 2026; Revised: July 18, 2026; Accepted: August 03, 2026; Published: August 22, 2026.

Citation: Omotayo BR, Iwuala DC. Association between Maternal Periodontal Disease and Spontaneous Preterm Birth Risk: A Prospective Cohort Study. International Journal of Obstetrics and Gynecology. 2026; 14(8): 495–506.