International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 265–276

DOI: 10.46882/2026/IJOG/000499

Original Research Article

Title: Long-Term Impact of Bariatric Surgery versus Intensive Lifestyle Modification on Fertility and Pregnancy Outcomes in Obese Anovulatory Women

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:
Obesity-induced anovulation presents significant therapeutic challenges in reproductive medicine. This prospective comparative cohort study evaluated the long-term impacts of laparoscopic sleeve gastrectomy bariatric surgery versus an intensive lifestyle modification program on ovulation restoration, spontaneous conception rates, and subsequent pregnancy outcomes in severely obese anovulatory women (BMI ≥ 35 kg/m²). One hundred and fifty women were followed over a 4-year period: bariatric group (n = 75) and lifestyle group (n = 75). At 24 months post-intervention, the bariatric group achieved a significantly higher mean percentage of total body weight loss compared to the lifestyle group (28.4% ± 5.2% vs. 7.1% ± 3.1%, p < 0.001). Spontaneous resumption of regular ovulatory cycles occurred in 82.7% of the surgical cohort versus 44.0% of the lifestyle cohort (p < 0.001). Over the follow-up timeline, the spontaneous pregnancy rate was higher in the bariatric group (61.3% vs. 32.0%, p = 0.001), with a shorter median time to conception. Regarding obstetric outcomes, women in the bariatric group had significantly lower rates of gestational diabetes (6.5% vs. 20.8%, p = 0.042) and preeclampsia (4.3% vs. 16.7%, p = 0.038) compared to the lifestyle arm. However, the incidence of small-for-gestational-age neonates was higher in the bariatric cohort (13.0% vs. 2.1%, p = 0.046). Bariatric surgery provides superior weight loss, higher ovulation restoration, and better spontaneous conception rates than intensive lifestyle modification, though it requires precise nutritional surveillance due to elevated fetal growth restriction risks.

Keywords: Obesity; Anovulation; Bariatric Surgery; Sleeve Gastrectomy; Lifestyle Modification; Spontaneous Conception.

Manuscript Timeline: Received: May 22, 2026; Revised: July 12, 2026; Accepted: August 01, 2026; Published: August 24, 2026.

Citation: Omotayo BR, Iwuala DC. Long-Term Impact of Bariatric Surgery versus Intensive Lifestyle Modification on Fertility and Pregnancy Outcomes in Obese Anovulatory Women. International Journal of Obstetrics and Gynecology. 2026; 14(8): 265–276.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 253–264

DOI: 10.46882/2026/IJOG/000498

Original Research Article

Title: A Prospective Cohort Study on the Impact of Maternal Vitamin D Status on Labor Progression and Primary Cesarean Section Rates

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

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

Abstract:
Vitamin D deficiency is implicated in altered myometrial contractility and poor pelvic muscle function, which might influence labor dynamics. This prospective cohort study examined the relationship between maternal serum 25-hydroxyvitamin D [25(OH)D] levels at term and the duration of labor stages or the incidence of primary cesarean delivery. Three hundred nulliparous women with singleton term pregnancies in spontaneous labor were enrolled. Serum 25(OH)D concentrations were measured at admission, categorizing women into three brackets: Deficient (< 20 ng/mL, n = 110), Insufficient (20 to 29.9 ng/mL, n = 105), and Sufficient (≥ 30 ng/mL, n = 85). Labor curves were tracked via digital partographs. Vitamin D deficiency was identified in 36.7% of the cohort. The mean duration of the active first stage of labor was significantly longer in the deficient group compared to the sufficient group (7.4 ± 2.1 hours vs. 5.2 ± 1.5 hours, p < 0.001). The primary cesarean delivery rate due to labor dystocia or arrest disorders was significantly higher among vitamin D-deficient women (22.7% vs. 8.2%; Odds Ratio [OR] = 3.24; 95% CI, 1.38 to 7.62; p = 0.007) compared to those with sufficient levels. Multi-variate logistic regression confirmed that low maternal vitamin D remained an independent predictor of labor arrest after controlling for age, BMI, and birth weight. Severe maternal vitamin D deficiency at term correlates with prolonged labor intervals and significantly raises the likelihood of primary cesarean section secondary to dystocia.

Keywords: Vitamin D Deficiency; Labor Progression; Cesarean Section; Labor Dystocia; Nulliparous; Partograph.

Manuscript Timeline: Received: May 19, 2026; Revised: July 10, 2026; Accepted: July 29, 2026; Published: August 20, 2026.

Citation: Aliyu FB, Bakare TM. A Prospective Cohort Study on the Impact of Maternal Vitamin D Status on Labor Progression and Primary Cesarean Section Rates. International Journal of Obstetrics and Gynecology. 2026; 14(8): 253–264.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 241–252

DOI: 10.46882/2026/IJOG/000497

Original Research Article

Title: Clinical Efficacy of Platelet-Rich Plasma Intrauterine Infusion for Thin Endometrium in Frozen Embryo Transfer Cycles

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:
A persistently thin endometrium (< 7 mm) impairs implantation rates and increases cycle cancellations in assisted reproduction. This prospective randomized controlled trial assessed whether intrauterine infusion of autologous Platelet-Rich Plasma (PRP) improves endometrial thickness and clinical pregnancy rates in women undergoing frozen embryo transfer (FET) cycles. One hundred and forty subfertile women with a history of thin endometrium despite maximal oral estrogen therapy were randomized to either the PRP group (n = 70) or the control group (n = 70). The PRP cohort received two separate intrauterine infusions of 0.5 mL autologous PRP on day 10 and day 12 of the hormone replacement therapy cycle, while the control group received standard care without infusions. Endometrial thickness was evaluated via transvaginal ultrasound on the day of progesterone initiation. Mean endometrial thickness increased significantly in the PRP group compared to the control group (7.6 ± 0.5 mm vs. 6.5 ± 0.4 mm, p < 0.001). Cycle cancellation due to inadequate endometrial thickness was significantly lower in the PRP group (2.9% vs. 17.1%, p = 0.006). Crucially, the clinical pregnancy rate per embryo transfer was significantly higher in the PRP cohort compared to controls (44.1% vs. 27.6%, p = 0.044), and the live birth rate also trended higher (36.8% vs. 20.7%, p = 0.048). Intrauterine infusion of autologous platelet-rich plasma effectively enhances endometrial proliferation and significantly optimizes clinical pregnancy rates in thin-endometrium FET cycles.

Keywords: Thin Endometrium; Platelet-Rich Plasma; Frozen Embryo Transfer; Endometrial Thickness; Clinical Pregnancy Rate; Assisted Reproduction.

Manuscript Timeline: Received: May 15, 2026; Revised: July 05, 2026; Accepted: July 26, 2026; Published: August 17, 2026.

Citation: Sanusi IK, Nwachukwu CJ. Clinical Efficacy of Platelet-Rich Plasma Intrauterine Infusion for Thin Endometrium in Frozen Embryo Transfer Cycles. International Journal of Obstetrics and Gynecology. 2026; 14(8): 241–252.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 229–240

DOI: 10.46882/2026/IJOG/000496

Original Research Article

Title: A Comparison of Mifepristone Combined with Misoprostol versus Misoprostol Alone for Second-Trimester Medical Termination of Pregnancy

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:
Second-trimester medical termination of pregnancy requires highly efficient drug regimens to reduce the induction-to-abortion interval and limit complications. This randomized, open-label trial evaluated the clinical efficacy and safety of oral mifepristone combined with vaginal misoprostol compared to vaginal misoprostol alone for termination between 14 and 22 weeks of gestation. One hundred and eighty women requiring pregnancy termination for fetal anomalies or medical indications were randomized into two equal groups (n = 90 per group). The combined group received 200 mg oral mifepristone followed 36 hours later by 400 μg vaginal misoprostol every 4 hours (maximum 5 doses). The single-agent group received a matching placebo followed by identical misoprostol protocols. The primary outcome was the mean induction-to-abortion interval. The combined regimen achieved a significantly shorter median induction-to-abortion interval compared to misoprostol alone (10.4 ± 3.1 hours vs. 16.8 ± 4.5 hours, p < 0.001). The successful abortion rate within 24 hours was significantly higher in the mifepristone-misoprostol arm (94.4% vs. 76.7%, p = 0.001). The total dosage of misoprostol required was also lower in the combined cohort (p < 0.001). Incidence of incomplete abortion requiring surgical evacuation was lower in the combined group (5.6% vs. 15.6%, p = 0.028). Maternal adverse effects, including nausea, chills, and diarrhea, did not differ significantly between the groups (p > 0.05). Pre-treatment with oral mifepristone significantly shortens the induction-to-abortion timeline and improves the complete success metrics of misoprostol-induced second-trimester termination.

Keywords: Medical Termination of Pregnancy; Mifepristone; Misoprostol; Second Trimester; Induction-to-Abortion Interval; Complete Abortion.

Manuscript Timeline: Received: May 12, 2026; Revised: July 04, 2026; Accepted: July 24, 2026; Published: August 14, 2026.

Citation: Bello MT, Effiong GE. A Comparison of Mifepristone Combined with Misoprostol versus Misoprostol Alone for Second-Trimester Medical Termination of Pregnancy. International Journal of Obstetrics and Gynecology. 2026; 14(8): 229–240.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 217–228

DOI: 10.46882/2026/IJOG/000495

Original Research Article

Title: Predictive Value of Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for Adverse Maternal-Fetal Outcomes in Late-Onset Preeclampsia

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:
Late-onset preeclampsia (occurring at or after 34 weeks of gestation) presents highly unpredictable clinical courses, requiring robust biomarkers to optimize delivery timelines. This prospective observational study evaluated the diagnostic accuracy of the serum soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio in predicting severe maternal and fetal complications within 14 days of clinical presentation. A cohort of 240 singleton pregnancies diagnosed with mild late-onset preeclampsia between 34 and 36⁺⁶ weeks was monitored. Serum concentrations of sFlt-1 and PlGF were measured at the time of initial diagnosis, and patients were followed until delivery. The primary composite endpoint included severe maternal complications (HELLP syndrome, eclampsia, placental abruption, or acute renal failure) or adverse neonatal outcomes (stillbirth, severe growth restriction, or neonatal intensive care admission) within two weeks. Sixty-two women (25.8%) experienced the composite endpoint. The median sFlt-1/PlGF ratio was significantly higher in women with adverse outcomes compared to those with stable courses (124.5 vs. 34.2, p < 0.001). An sFlt-1/PlGF ratio threshold ≥ 85 demonstrated a sensitivity of 87.1%, a specificity of 83.1%, a positive predictive value of 64.3%, and a negative predictive value of 94.7% for forecasting complications within 14 days. Receiver operating characteristic analysis yielded an Area Under the Curve [AUC] of 0.89. The sFlt-1/PlGF ratio serves as an effective diagnostic tool in late-onset preeclampsia to identify patients at imminent risk of severe complications, guiding inpatient management and safe delivery choices.

Keywords: Late-Onset Preeclampsia; sFlt-1/PlGF Ratio; Angiogenic Biomarkers; Maternal Complications; Placental Growth Factor; Perinatal Surveillance.

Manuscript Timeline: Received: May 10, 2026; Revised: July 01, 2026; Accepted: July 22, 2026; Published: August 11, 2026.

Citation: Adebayo OA, Okafor CO, Yusuf AZ. Predictive Value of Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for Adverse Maternal-Fetal Outcomes in Late-Onset Preeclampsia. International Journal of Obstetrics and Gynecology. 2026; 14(8): 217–228.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 205–216

DOI: 10.46882/2026/IJOG/000494

Original Research Article

Title: Efficacy of Prophylactic Intracervical Injection of Vasopressin during Laparoscopic Myomectomy: A Double-Blind Randomized Controlled Trial

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:
Intraoperative blood loss during laparoscopic myomectomy can complicate visual fields and increase conversion rates to open laparotomy. This double-blind, placebo-controlled randomized trial investigated the efficacy and safety of a prophylactic intracervical/perimyometrial injection of diluted vasopressin in reducing blood loss during laparoscopic uterine leiomyoma excision. One hundred and twenty women scheduled for laparoscopic myomectomy for intramural or subserosal fibroids (at least one fibroid ≥ 6 cm) were randomized to receive either 20 units of vasopressin diluted in 100 mL of 0.9% saline (n = 60) or 100 mL of a pure saline placebo (n = 60) injected into the myometrium surrounding the target lesions prior to uterine incision. The primary endpoint evaluated was total intraoperative blood loss. The mean intraoperative blood loss was significantly lower in the vasopressin group compared to the placebo group (142.5 ± 50.4 mL vs. 310.8 ± 95.6 mL, p < 0.001). The requirement for intraoperative blood transfusions was also lower in the vasopressin cohort (0.0% vs. 6.7%, p = 0.043). Furthermore, the mean operative duration was significantly reduced by vasopressin administration due to improved visual fields (58.4 ± 14.2 minutes vs. 76.5 ± 18.4 minutes, p < 0.001). Transient intraoperative cardiovascular fluctuations (mild bradycardia or elevated blood pressure) occurred in 8.3% of the vasopressin group but resolved spontaneously within 5 minutes. Prophylactic injection of diluted vasopressin significantly limits surgical hemorrhage, shortens operative times, and eliminates blood transfusion requirements during laparoscopic myomectomy without causing serious adverse systemic effects.

Keywords: Laparoscopic Myomectomy; Vasopressin; Intraoperative Blood Loss; Uterine Fibroids; Blood Transfusion; Operative Time.

Manuscript Timeline: Received: May 05, 2026; Revised: June 28, 2026; Accepted: July 20, 2026; Published: August 08, 2026.

Citation: Eze CE, Umar AM. Efficacy of Prophylactic Intracervical Injection of Vasopressin during Laparoscopic Myomectomy: A Double-Blind Randomized Controlled Trial. International Journal of Obstetrics and Gynecology. 2026; 14(8): 205–216.