International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 483–494

DOI: 10.46882/2026/IJOG/000521

Original Research Article

Title: Efficacy of Intravaginal Estriol versus Hyaluronic Acid Gel for the Treatment of Vaginal Dryness in Breast Cancer Survivors

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:
Managing severe genitourinary symptoms in breast cancer survivors on endocrine therapies is limited by concerns regarding hormonal absorption. This randomized, double-blind clinical trial compared the clinical efficacy and safety of a non-hormonal hyaluronic acid vaginal gel versus ultra-low-dose local estriol cream for treating severe vaginal dryness in breast cancer survivors. One hundred patients currently receiving tamoxifen or aromatase inhibitors were randomized to receive either 5 mg hyaluronic acid gel (n = 50) or 0.1 mg estriol cream (n = 50) three times weekly for 12 weeks. The primary outcome was changes in subjective vaginal dryness scored via a visual analog scale (VAS) and serial serum estradiol tracking. At week 12, both groups achieved a significant reduction in mean vaginal dryness scores from baseline (p < 0.001), with no significant difference between the two treatment arms (hyaluronic acid: -4.2 ± 1.1 points; estriol: -4.6 ± 1.3 points, p = 0.18). Objective improvements in the Vaginal Health Index were also comparable (p = 0.24). Crucially, serum estradiol monitoring remained strictly within normal postmenopausal ranges (< 5 pg/mL) in the hyaluronic acid group, whereas 8.0% of patients in the estriol cohort demonstrated transient elevations above baseline values (p = 0.034). Intravaginal hyaluronic acid gel provides symptom relief non-inferior to ultra-low-dose estriol cream, serving as a highly effective, safe non-hormonal option for managing vulvovaginal atrophy in breast cancer survivors.

Keywords: Vaginal Dryness; Hyaluronic Acid; Estriol; Breast Cancer Survivors; Vulvovaginal Atrophy; Endocrine Therapy.

Manuscript Timeline: Received: May 27, 2026; Revised: July 15, 2026; Accepted: August 01, 2026; Published: August 19, 2026.

Citation: Cole OO, Chuka NC. Efficacy of Intravaginal Estriol versus Hyaluronic Acid Gel for the Treatment of Vaginal Dryness in Breast Cancer Survivors. International Journal of Obstetrics and Gynecology. 2026; 14(8): 483–494.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 471–482

DOI: 10.46882/2026/IJOG/000520

Original Research Article

Title: A Multi-Center Cohort Study on the Impact of Maternal Age on Chromosomal Mosaicism in Trophectoderm Biopsies

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:
Embryonic chromosomal mosaicism poses a major interpretive challenge during preimplantation genetic testing for aneuploidies (PGT-A). This multi-center prospective cohort study investigated whether advanced maternal age correlates with an increased prevalence of chromosomal mosaicism within trophectoderm biopsies. A database of 2,400 blastocysts undergoing trophectoderm biopsy across three IVF laboratories was analyzed utilizing high-resolution next-generation sequencing (NGS). Blastocysts were classified as euploid, aneuploid, or mosaic (defined as containing 20% to 50% abnormal cell lines). Results were stratified across four maternal age brackets: < 35 years (n = 800), 35 to 37 years (n = 650), 38 to 40 years (n = 550), and > 40 years (n = 400). While the absolute incidence of full aneuploidy increased linearly with maternal age (p < 0.001), the proportion of mosaic blastocysts remained remarkably stable across all cohorts: 14.2% in < 35 years, 15.1% in 35 to 37 years, 13.8% in 38 to 40 years, and 14.5% in > 40 years (p = 0.84). Multi-variate logistic regression confirmed that maternal age was not an independent predictor of trophectoderm mosaicism (Odds Ratio = 1.02; 95% CI, 0.94 to 1.11, p = 0.68). In contrast, specific controlled ovarian hyperstimulation parameters and embryology laboratory conditions significantly influenced mosaicism rates (p = 0.012). Unlike complete meiotic aneuploidies, mitotic chromosomal mosaicism in trophectoderm cells occurs independently of maternal age, highlighting the influence of post-zygotic replication mechanics rather than oocyte aging.

Keywords: Preimplantation Genetic Testing; Chromosomal Mosaicism; Trophectoderm Biopsy; Advanced Maternal Age; Next-Generation Sequencing; Aneuploidy.

Manuscript Timeline: Received: May 25, 2026; Revised: July 12, 2026; Accepted: July 30, 2026; Published: August 16, 2026.

Citation: Bello MT, Effiong GE. A Multi-Center Cohort Study on the Impact of Maternal Age on Chromosomal Mosaicism in Trophectoderm Biopsies. International Journal of Obstetrics and Gynecology. 2026; 14(8): 471–482.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 459–470

DOI: 10.46882/2026/IJOG/000519

Original Research Article

Title: Predictive Performance of First-Trimester Serum PlGF and sFlt-1 Matrix for Gestational Hypertension Stratification

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

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

Abstract:
Early tracking of women prone to gestational hypertensive disorders allows for targeted preventative surveillance. This prospective cohort study assessed the diagnostic accuracy of first-trimester serum soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) concentrations in predicting the subsequent development of gestational hypertension. A total of 550 asymptomatic nulliparous women were screened between 11 and 13⁺⁶ weeks of gestation. Serum biomarker levels were quantified via automated immunoassays and converted to Multiples of the Median (MoM). Patients were tracked dynamically until delivery, and the primary endpoint was the development of de novo hypertension after 20 weeks. Fifty-two women (9.5%) developed gestational hypertension. Women who developed the condition exhibited significantly lower median PlGF levels (0.64 MoM vs. 1.02 MoM, p < 0.001) and elevated sFlt-1/PlGF ratios (48.4 ± 12.2 vs. 22.5 ± 6.8, p < 0.001) in the first trimester compared to those who remained normotensive. A multivariable predictive risk index incorporating maternal mean arterial pressure (MAP), uterine artery pulsatility index, and the sFlt-1/PlGF ratio demonstrated a diagnostic sensitivity of 82.7%, a specificity of 86.3%, and an Area Under the Curve (AUC) of 0.91. First-trimester screening utilizing maternal serum angiogenic biomarkers linked with clinical blood pressure measurements provides an exceptional, highly reproducible risk matrix to identify women likely to experience gestational hypertension long before clinical signs manifest.

Keywords: Gestational Hypertension; Placental Growth Factor; sFlt-1; First-Trimester Screening; Angiogenic Biomarkers; Risk Stratification.

Manuscript Timeline: Received: May 22, 2026; Revised: July 10, 2026; Accepted: July 28, 2026; Published: August 14, 2026.

Citation: Aliyu FB, Bakare TM. Predictive Performance of First-Trimester Serum PlGF and sFlt-1 Matrix for Gestational Hypertension Stratification. International Journal of Obstetrics and Gynecology. 2026; 14(8): 459–470.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 447–458

DOI: 10.46882/2026/IJOG/000518

Original Research Article

Title: Prophylactic Use of Oxytocin Combined with Ergometrine versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Twin Vaginal Deliveries

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:
Twin vaginal births carry a heightened risk of uterine atony and subsequent postpartum hemorrhage (PPH) due to overdistension of the myometrium. This double-blind randomized controlled trial compared the clinical efficacy and safety of a combined uterotonic regimen (intravenous oxytocin plus intramuscular ergometrine) against standard intravenous oxytocin alone for PPH prophylaxis following twin vaginal deliveries. Two hundred pregnant women with twin gestations at term attempting vaginal delivery were randomized into two equal groups (n = 100 per group). Immediately following the delivery of the second twin, the combined group received 5 IU intravenous oxytocin bolus plus 0.5 mg intramuscular ergometrine, while the single-agent group received 5 IU intravenous oxytocin plus an intramuscular saline placebo. The primary endpoint evaluated was the incidence of blood loss ≥ 500 mL. The incidence of PPH was significantly lower in the combined uterotonic group compared to the oxytocin-only group (8.0% vs. 19.0%; Relative Risk [RR] = 0.42; 95% CI, 0.20 to 0.89; p = 0.021). The mean total blood loss was also significantly reduced in the combined cohort (425.4 ± 115.8 mL vs. 580.6 ± 165.4 mL, p < 0.001). However, maternal adverse events, including transient hypertension (12.0% vs. 2.0%, p = 0.006) and postpartum nausea/vomiting (15.0% vs. 4.0%, p = 0.008), were more frequent in the combined arm. Prophylactic administration of oxytocin combined with ergometrine provides significantly superior protection against postpartum hemorrhage during twin vaginal deliveries, though careful maternal blood pressure screening is essential.

Keywords: Twin Vaginal Delivery; Postpartum Hemorrhage; Oxytocin; Ergometrine; Uterine Atony; Maternal Hemodynamics.

Manuscript Timeline: Received: May 20, 2026; Revised: July 08, 2026; Accepted: July 26, 2026; Published: August 11, 2026.

Citation: Obi EJ, Adeyemi FR, Dogara ZH. Prophylactic Use of Oxytocin Combined with Ergometrine versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Twin Vaginal Deliveries. International Journal of Obstetrics and Gynecology. 2026; 14(8): 447–458.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 435–446

DOI: 10.46882/2026/IJOG/000517

Original Research Article

Title: A Randomized Controlled Trial of Intragastric Ballon Insertion versus Metformin for Methemoglobin-Induced Anovulation in Severe PCOS

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:
Polycystic Ovary Syndrome (PCOS) complicated by severe obesity presents complex metabolic blocks that impair normal ovulatory functions. This randomized open-label trial evaluated whether rapid weight loss induced via an endoscopic intragastric balloon (IGB) achieves superior ovulation restoration and insulin sensitivity compared to maximal metformin therapy in severely obese anovulatory women with PCOS. One hundred participants aged 18 to 35 years with a BMI ≥ 35 kg/m² and confirmed anovulation were randomized to receive either an fluid-filled IGB for 6 months (n = 50) or oral metformin titrated up to 2,000 mg daily (n = 50). The primary outcome was the percentage of women achieving spontaneous ovulation, confirmed via serial serum progesterone measurements (≥ 10 nmol/L) at month 6. The mean body weight loss was significantly higher in the IGB cohort compared to the metformin cohort (18.4% ± 3.5% vs. 4.2% ± 1.8%, p < 0.001). Spontaneous ovulatory cycles were restored in 76.0% of the IGB group compared to 38.0% of the metformin group (p < 0.001). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values improved substantially more in the balloon arm (mean reduction of 2.15 ± 0.45 vs. 0.85 ± 0.22, p < 0.001). Free testosterone concentrations also dropped further in the IGB cohort (p = 0.004). Endoscopic intragastric balloon placement drives superior weight reduction, leading to higher spontaneous ovulation restoration and improved insulin kinetics in severely obese anovulatory women with polycystic ovary syndrome.

Keywords: Polycystic Ovary Syndrome; Intragastric Balloon; Metformin; Weight Loss; Spontaneous Ovulation; Insulin Resistance.

Manuscript Timeline: Received: May 18, 2026; Revised: July 05, 2026; Accepted: July 24, 2026; Published: August 09, 2026.

Citation: Sanusi IK, Nwachukwu CJ. A Randomized Controlled Trial of Intragastric Ballon Insertion versus Metformin for Methemoglobin-Induced Anovulation in Severe PCOS. International Journal of Obstetrics and Gynecology. 2026; 14(8): 435–446.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 423–434

DOI: 10.46882/2026/IJOG/000516

Original Research Article

Title: Diagnostic Accuracy of Magnetic Resonance Imaging versus Transvaginal Ultrasound in Mapping Deep Infiltrating Endometriosis

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:
Deep Infiltrating Endometriosis (DIE) is characterized by lesions penetrating greater than 5 mm beneath the peritoneal surface, necessitating accurate preoperative mapping. This prospective diagnostic study compared the accuracy of Magnetic Resonance Imaging (MRI) against transvaginal ultrasound (TVUS) optimized with a bowel preparation protocol for mapping specific DIE locations. One hundred and twenty symptomatic women scheduled for laparoscopic excision of pelvic endometriosis underwent both TVUS and 1.5-T pelvic MRI preoperatively. Findings from both modalities were verified against surgical visualization and histopathological confirmation, which served as the gold standard. DIE was confirmed pathologically in 84 patients (70.0%). For rectosigmoid colon lesions, TVUS and MRI demonstrated comparable sensitivities (85.2% vs. 88.9%, p = 0.54) and specificities (94.1% vs. 95.6%, p = 0.62). However, for detecting uterosacral ligament lesions, MRI achieved a significantly higher sensitivity than TVUS (89.3% vs. 71.4%, p = 0.008), though specificities remained statistically equivalent (88.9% vs. 90.5%, p = 0.74). For bladder lesions, MRI also trended toward higher diagnostic precision (sensitivity 87.5% vs. 62.5%, p = 0.046). The overall accuracy for mapping overall posterior compartment lesions was 90.8% for MRI and 81.7% for TVUS (p = 0.012). While TVUS optimized with bowel preparation remains an excellent, highly cost-effective first-line diagnostic modality for intestinal mapping, pelvic MRI provides superior diagnostic accuracy for tracking deep infiltrating endometriosis within the uterosacral and anterior retroperitoneal spaces.

Keywords: Deep Infiltrating Endometriosis; Magnetic Resonance Imaging; Transvaginal Ultrasound; Diagnostic Sensitivity; Preoperative Mapping; Pelvic Laparoscopy.

Manuscript Timeline: Received: May 15, 2026; Revised: July 03, 2026; Accepted: July 22, 2026; Published: August 06, 2026.

Citation: Nwosu AP, Kudoyin ST. Diagnostic Accuracy of Magnetic Resonance Imaging versus Transvaginal Ultrasound in Mapping Deep Infiltrating Endometriosis. International Journal of Obstetrics and Gynecology. 2026; 14(8): 423–434.