International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 999–1010

DOI: 10.46882/2026/IJOG/000564

Original Research Article

Title: Efficacy of Prophylactic Double-Lumen versus Single-Lumen Needle for Oocyte Retrieval in Advanced Maternal Age IVF Cycles

Names of Authors: Sophia Lindstrom¹, Anna Kowalski²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
² Department of Gynaecology and Obstetrics, Medical University of Warsaw, Warsaw, Poland

Abstract:
Follicular aspiration in patients of advanced maternal age (AMA) requires high operational optimization to avoid losing scarce competent oocytes. This prospective randomized clinical trial compared the oocyte yield, total aspiration duration, and pelvic pain profiles of a double-lumen follicle aspiration needle enabling continuous flushing versus a standard single-lumen aspiration needle. One hundred subfertile women aged 39 to 43 years undergoing controlled ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) were randomized to either the double-lumen needle arm (n = 50) or the single-lumen needle arm (n = 50) during transvaginal ultrasound-guided oocyte retrieval. 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 groups (3.2 ± 1.1 vs. 3.0 ± 1.3, p = 0.45). The fertilization and subsequent high-grade blastocyst transformation 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 repetitive flushing phases (18.4 ± 3.5 minutes vs. 9.5 ± 2.1 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 AMA patients with diminished ovarian reserves, utilizing a double-lumen needle for routine follicular flushing does not improve mature oocyte yields but prolongs surgical timelines and increases immediate postoperative pelvic discomfort.

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

Manuscript Timeline: Received: June 30, 2026; Revised: August 25, 2026; Accepted: September 12, 2026; Published: September 20, 2026.

Citation: Lindstrom S, Kowalski A. Efficacy of Prophylactic Double-Lumen versus Single-Lumen Needle for Oocyte Retrieval in Advanced Maternal Age IVF Cycles. International Journal of Obstetrics and Gynecology. 2026; 14(9): 999–1010.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1023–1034

DOI: 10.46882/2026/IJOG/000566

Original Research Article

Title: A Randomized Controlled Trial of Prophylactic Bakri Balloon Tamponade versus Standard Oxytocin Infusion for Placenta Previa Hemorrhage prevention

Names of Authors: William Brooks¹, Lars Eriksson²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom
² Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway

Abstract:
Placenta previa is associated with severe intraoperative and postpartum hemorrhage originating from a poorly contractile lower uterine segment during cesarean section. This randomized controlled trial evaluated the efficacy of prophylactic Bakri balloon tamponade placement immediately following placental extraction during cesarean delivery for complete placenta previa. One hundred and twenty pregnant women undergoing scheduled cesarean sections for complete placenta previa were randomized to either the prophylactic Bakri balloon group (n = 60) or the conventional management control group (oxytocin infusion plus standard surgical hemostatic sutures; n = 60). The primary outcome measured was total calculated perioperative blood loss. The mean total intraoperative and postoperative blood loss was significantly lower in the Bakri balloon group compared to the control group (642.5 ± 180.4 mL vs. 982.6 ± 285.4 mL, p < 0.001). The requirement for emergency secondary surgical interventions, such as uterine artery ligation or B-Lynch sutures, was significantly reduced in the balloon cohort (1.7% vs. 11.7%, p = 0.028). Blood transfusion requirements were also significantly decreased in the prophylactic intervention arm (5.0% vs. 18.3%, p = 0.024). There were no cases of balloon displacement, uterine rupture, or secondary pelvic infections in the intervention group. Prophylactic application of the Bakri balloon tamponade during cesarean sections for complete placenta previa is a safe strategy that effectively reduces perioperative blood loss and limits additional surgical interventions.

Keywords: Placenta Previa; Bakri Balloon; Postpartum Hemorrhage; Cesarean Section; Balloon Tamponade; Blood Transfusion.

Manuscript Timeline: Received: July 05, 2026; Revised: September 02, 2026; Accepted: September 16, 2026; Published: September 26, 2026.

Citation: Brooks W, Eriksson L. A Randomized Controlled Trial of Prophylactic Bakri Balloon Tamponade versus Standard Oxytocin Infusion for Placenta Previa Hemorrhage prevention. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1023–1034.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 987–998

DOI: 10.46882/2026/IJOG/000563

Original Research Article

Title: Clinical Efficacy of Single-Port vNOTES versus Multi-Port Conventional Laparoscopy for Benign Ovarian Cystectomy

Names of Authors: Charlotte de Jong¹, Emily R. Watson²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
² Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia

Abstract:
Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) provides an alternative minimally invasive pathway that avoids visible abdominal skin incisions. This prospective randomized controlled trial compared the perioperative surgical outcomes, early postoperative pain patterns, and cosmetic satisfaction profiles of single-port vNOTES cystectomy against multi-port Conventional Laparoscopy (CL) for benign adnexal masses. One hundred and twenty women presenting with unilateral benign ovarian cysts (maximum diameter ≤ 8 cm) requiring surgical removal were randomized to either the vNOTES cohort (n = 60) or the CL cohort (n = 60). The primary outcomes were total operative duration and visual analog scale (VAS) pain scores at 12 and 24 hours postoperatively. The mean operative duration was significantly shorter in the vNOTES group compared to the CL group (38.4 ± 9.2 minutes vs. 52.6 ± 12.4 minutes, p < 0.001). Postoperative VAS pain scores were lower in the vNOTES group at 12 hours (1.8 ± 0.5 vs. 3.6 ± 1.1, p < 0.001) and 24 hours (1.1 ± 0.3 vs. 2.2 ± 0.5, p < 0.001), resulting in a 35.0% reduction in total postoperative ward analgesic consumption. Cosmetic satisfaction scores recorded at week 6 were significantly higher in the single-incision vaginal arm (9.8 ± 0.2 vs. 7.6 ± 1.1, p < 0.001). Single-port vNOTES for benign ovarian cystectomy is an efficient intervention that shortens operational intervals, limits early postoperative pain, and eliminates abdominal scarring compared to conventional multi-port laparoscopy.

Keywords: vNOTES; Laparoscopy; Ovarian Cystectomy; Postoperative Pain; Cosmetic Outcome; Minimally Invasive Surgery.

Manuscript Timeline: Received: June 28, 2026; Revised: August 22, 2026; Accepted: September 10, 2026; Published: September 18, 2026.

Citation: de Jong C, Watson ER. Clinical Efficacy of Single-Port vNOTES versus Multi-Port Conventional Laparoscopy for Benign Ovarian Cystectomy. International Journal of Obstetrics and Gynecology. 2026; 14(9): 987–998.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 975–986

DOI: 10.46882/2026/IJOG/000562

Original Research Article

Title: A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Symptomatic Intramural Adenomyosis

Names of Authors: Min-Ji Kim¹, Sophie Dubois²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
² Service de Gynécologie, Centre Hospitalier Universitaire de Lyon, Lyon, France

Abstract:
Diffuse or focal intramural adenomyosis induces severe dysmenorrhea and heavy menstrual bleeding (HMB), posing therapeutic challenges for conservative tissue-sparing surgical interventions. This randomized controlled trial compared the 12-month efficacy, volume shrinkage index, and safety of ultrasound-guided High-Intensity Focused Ultrasound (HIFU) thermal ablation against Laparoscopic Adenomyomectomy/Ablation (LA). One hundred premenopausal women with confirmed focal intramural adenomyosis (lesion diameter 5 to 9 cm) were randomized in a 1:1 ratio (n = 50 per group). Primary endpoints were reductions in dysmenorrhea visual analog scale (VAS) scores and adenomyoma volume reduction rates at month 12. At the 12-month evaluation, both groups demonstrated equivalent, significant reductions in dysmenorrhea VAS scores from baseline (HIFU: -4.6 ± 1.2 points; LA: -4.9 ± 1.4 points, p = 0.18). The mean focal adenomyoma volume reduction rate was 64.2% ± 10.5% in the HIFU cohort, whereas the LA cohort achieved complete surgical resection (100%). However, the HIFU cohort demonstrated significantly shorter hospital stay durations (6.2 hours vs. 48.4 hours, p < 0.001) and an earlier return to work. Major procedural complications, including deep pelvic hematomas or wound infections, were absent in the HIFU group but occurred in 6.0% of the LA group (p = 0.041). Non-invasive HIFU ablation provides dysmenorrhea relief and health-related quality of life improvements equivalent to laparoscopic surgery, while minimizing perioperative morbidity and hospital stay requirements.

Keywords: Adenomyosis; High-Intensity Focused Ultrasound; Laparoscopic Surgery; Dysmenorrhea; Quality of Life; Thermal Ablation.

Manuscript Timeline: Received: June 25, 2026; Revised: August 20, 2026; Accepted: September 08, 2026; Published: September 15, 2026.

Citation: Kim MJ, Dubois S. A Randomized Controlled Trial of High-Intensity Focused Ultrasound versus Laparoscopic Ablation for Symptomatic Intramural Adenomyosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 975–986.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 951–962

DOI: 10.46882/2026/IJOG/000560

Original Research Article

Title: A Randomized Controlled Trial of Intravaginal Prasterone versus Hyaluronic Acid Gel for Vulvovaginal Atrophy in Postmenopausal Breast Cancer Survivors

Names of Authors: Chloé Mercier¹, Alessandra Rossi²

Authors’ Affiliations:
¹ Département de Gynécologie-Obstétrique, Hôpital Européen Georges-Pompidou, Paris, France
² Unità de Ginecologia e Ostetricia, Ospedale San Raffaele, Milan, Italy

Abstract:
Managing severe genitourinary symptoms in postmenopausal breast cancer survivors undergoing aromatase inhibitor therapy is restricted by absolute contraindications to systemic or local estrogen creams. This randomized, double-blind active-controlled clinical trial compared the tissue-restoring efficacy and hormonal safety profile of once-daily non-estrogenic intravaginal prasterone (DHEA, 6.5 mg) capsules versus a non-hormonal hyaluronic acid vaginal gel. One hundred and forty breast cancer survivors presenting with moderate-to-severe vaginal dryness and dyspareunia were randomized into two equal groups (n = 70 per group) for a treatment course of 12 weeks. Primary outcomes were updates to the Vaginal Health Index (VHI) score, vaginal pH drops, and serial serum estradiol tracking using high-sensitivity mass spectrometry. At week 12, both groups achieved a significant reduction in subjective dyspareunia scores (p < 0.001). However, the prasterone cohort demonstrated a significantly greater increase in mean VHI scores (21.4 ± 2.2 vs. 16.5 ± 1.8, p < 0.001) and a more pronounced vaginal pH reduction below 4.6 (p = 0.003) compared to the hyaluronic acid group. Crucially, serial blood sampling confirmed that serum estradiol levels remained strictly within safe postmenopausal baseline margins (< 5 pg/mL) in both treatment branches. Daily intravaginal prasterone provides superior local tissue rejuvenation and symptom relief for vulvovaginal atrophy in breast cancer survivors compared to non-hormonal lubricants without causing systemic estrogen reabsorption.

Keywords: Vulvovaginal Atrophy; Prasterone; Breast Cancer Survivors; Hyaluronic Acid; Dyspareunia; Intracrinology.

Manuscript Timeline: Received: June 20, 2026; Revised: August 15, 2026; Accepted: September 05, 2026; Published: September 10, 2026.

Citation: Mercier C, Rossi A. A Randomized Controlled Trial of Intravaginal Prasterone versus Hyaluronic Acid Gel for Vulvovaginal Atrophy in Postmenopausal Breast Cancer Survivors. International Journal of Obstetrics and Gynecology. 2026; 14(9): 951–962.

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 963–974

DOI: 10.46882/2026/IJOG/000561

Original Research Article

Title: Efficacy of Prophylactic Intravenous Tranexamic Acid in Minimizing Hemorrhage during Open Myomectomy for Multiple Uterine Myomas

Names of Authors: Mateo Fernandez¹, David Goldstein²

Authors’ Affiliations:
¹ Departamento de Obstetricia y Ginecología, Hospital Clínic de Barcelona, Barcelona, Spain
² Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Abstract:
Abdominal myomectomy for multiple large uterine leiomyomas carries an inherent risk of massive intraoperative blood loss, frequently necessitating emergency red blood cell transfusions. This double-blind, placebo-controlled randomized clinical trial investigated the hemostatic efficacy and safety of prophylactic intravenous Tranexamic Acid (TXA) administration in limiting surgical bleeding. One hundred and forty premenopausal women undergoing open abdominal myomectomy for the removal of at least four uterine fibroids (uterine volume equivalent to ≥ 14 weeks) were randomized to receive either 1 g of intravenous TXA (n = 70) or a matching 0.9% saline placebo (n = 70) slowly 20 minutes prior to skin incision. The primary endpoint evaluated was total intraoperative and postoperative blood loss calculated via gravimetric and hemometatric parameters. The mean total calculated blood loss was significantly lower in the TXA cohort compared to the placebo cohort (312.5 ± 85.4 mL vs. 495.6 ± 132.8 mL, p < 0.001). Postoperative hemoglobin drop evaluated 24 hours after surgery was also significantly smaller in the TXA group (0.68 ± 0.22 g/dL vs. 1.25 ± 0.42 g/dL, p < 0.001). Homologous blood transfusion was required for only 1.4% of the TXA group compared to 10.0% of the placebo group (p = 0.028). No thrombotic adverse events occurred within 6 weeks post-surgery. Prophylactic administration of tranexamic acid significantly limits surgical blood loss and minimizes transfusion dependencies during extensive open myomectomy procedures.

Keywords: Tranexamic Acid; Abdominal Myomectomy; Uterine Fibroids; Surgical Hemorrhage; Hemoglobin Drop; Hemostasis.

Manuscript Timeline: Received: June 22, 2026; Revised: August 18, 2026; Accepted: September 06, 2026; Published: September 12, 2026.

Citation: Fernandez M, Goldstein D. Efficacy of Prophylactic Intravenous Tranexamic Acid in Minimizing Hemorrhage during Open Myomectomy for Multiple Uterine Myomas. International Journal of Obstetrics and Gynecology. 2026; 14(9): 963–974.