Tecla Lyamuya

Ovarian torsion of a large mature cystic teratoma complicating early pregnancy: a rare case report

Introduction and Importance: Adnexal torsion complicating early pregnancy is rare but should be suspected in pregnant women presenting with acute lower abdominal pain. Mature cystic teratomas (MCTs) are common benign ovarian tumors in women of reproductive age, but their occurrence during pregnancy complicated by torsion is rare. MCTs comprise 20% of all ovarian neoplasms and are commonly encountered in patients between 20 and 40 years of age. Early diagnosis is challenging due to overlapping symptoms with common pregnancy-related conditions, yet prompt recognition and intervention are crucial to preserve maternal and fetal outcomes. This case report aims to highlight the diagnostic and management challenges of adnexal torsion complicating early pregnancy. Case Presentation: We report the case of a 21-year-old primigravida from Northern Tanzania who presented at gestational age of 11 weeks and 4 days of gestation with a sudden-onset history of left lower abdominal pain for 6 h that progressively worsened over time. Abdominal ultrasonography revealed a large left adnexal cystic mass with internal echoes, thickened walls, and posterior acoustic enhancement, measuring 14.0 × 10.4 × 9.3 cm, consistent with a complex ovarian cyst. The uterus was enlarged and contained a viable intrauterine pregnancy with a crown–rump length of 48.6 mm, corresponding to 11 weeks and 4 days of gestation with active cardiac activity. The patient underwent an emergency laparotomy, which confirmed a viable intrauterine pregnancy alongside a large, twisted left ovarian cystic mass measuring 19.0 × 14.0 × 10.0 cm, with torsion of its pedicle around the mesovarium. Detorsion and left salpingo-oophorectomy were performed successfully. Histopathological examination confirmed the diagnosis of a MCT. Postoperative recovery was uneventful, and follow-up at 23 weeks showed a viable ongoing pregnancy. Clinical Discussion: MCTs are prone to torsion due to their size and mobility. Early surgical management is critical to prevent ischemic necrosis and ensure optimal maternal and fetal outcomes. In this case, a timely laparotomy and removal of the affected adnexa resulted in a favorable recovery and continuation of pregnancy. Conclusion: Ovarian torsion due to a MCT in early pregnancy is a rare but important differential diagnosis for acute abdominal pain. Prompt recognition and surgical intervention are vital to preserving maternal health and supporting pregnancy continuation.

Barriers to adherence to cervical cancer screening care in Northern Tanzania

Abstract Background Cervical cancer disproportionately affects women in low- and middle-income countries compared to those in high-income countries because of the difference in quality and effectiveness of cervical cancer screening programs. An essential part of effective cervical cancer prevention is the continuum of care for a woman with a suspicious cervical lesion (SCL) consisting of appropriate treatment and, in Tanzania, a follow-up screening one year after treatment. This study aimed at identifying factors associated with non-adherence to the scheduled follow-up after treatment of a SCL. Additionally, the cervical cancer screening results one year after treatment were evaluated. Methods A total of 219 clients treated for a SCL between 2017 and 2021 from 8 centres in the Kilimanjaro region were interviewed. Contact and medical information of the clients was obtained at the facilities. Additionally, 11 in-depth interviews with healthcare providers were conducted. Results In the quantitative study, 143 (65.3%) clients treated for suspicious cervical lesions adhered to the recommended follow-up appointment. Significant factors associated with poor adherence were individual barriers such as failure to understand why they should return and access barriers to the health facility. The health workers mentioned a lack of awareness and financial challenges regarding transportation. Conclusion The complete journey of high-risk women needs attention, otherwise the primary screening will not be effective. Additional efforts are needed to address knowledge gaps and socio-economic problems during the follow-up.