BackgroundTeratomas are a germ cell tumors composed of two or more tissues which originate from ectoderm, endoderm or mesoderm. These tumors commonly arise from the ovary although other extragonadal sites can be involved, especially in children.Case presentationWe report a case of a 21-year-old female of Sukuma ethnicity from the northern region of Tanzania who presented with abdominal pain and distension, fever, and abnormal vaginal discharge for the previous three weeks. The patient was also lactating for the previous 8 months following cesarean section delivery. Pelvic ultrasound suggested pelvic abscess but after laparotomy and histological analysis of a bulky uterus removed a diagnosis of mature uterine teratoma was confirmed.ConclusionAlthough it is rare, uterine teratoma should be considered in differential diagnosis to any patient with uterine mass even without typical radiological findings.

Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.

IntroductionFetus papyraceus is a rare condition which describes a mummified fetus in a multiple gestation pregnancy in which one fetus dies and becomes flattened between the membranes of the other fetus and uterine wall. We report a case of fetus papyraceus diagnosed during labor as a result of arrested descent.Case presentationA 23-year-old Sukuma woman, gravida 2, para 1 presented to an maternity emergency unit of Sengerema Designated District hospital at a gestation age of 35+5 weeks as a referral from a rural health center due to arrested descent despite being in active labor for the past 8 hours. On vaginal examination, her cervix was 6cm dilated; fully effaced, presenting part was at station −3. A sharp and solid object-like thing was felt on the right side of her cervix. Due to uncertainty of the presenting part together with arrested descent, a decision was reached to deliver her by caesarean section. A twin gestation was identified during caesarean section: one being a male baby in cephalic presentation, weighing 1.9kg with Apgar score 8 in first minute and 9 in fifth minute with its own normal placenta and membranes. There was another atrophied placenta with calcifications without a cord and with mummified fetal bones on the anterior to the lower segment at the level of the internal orifice of the uterus. The atrophied placenta and mummified fetal bones weighed 200gms. One unit of blood was transfused intraoperatively due to severe anemia prior to surgery. Both the mother and the baby were discharged home in good condition.ConclusionsThe primary concern for fetus papyraceus is its effect on the surviving fetus and on the mother. To avoid possible complications, the intrauterine diagnosis of fetus papyraceus by serial ultrasound examinations and routine placental examination to search for fetus papyraceus is mandatory.