Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ Diminished Returns (MDRs) posits that structural racism, segregation, and labor market discrimination limit the benefits of socioeconomic resources, such as education, for Black and Latino individuals. This suggests that the effects of education on maternity leave may not be uniform across racial and ethnic groups. Objective: This study aimed to examine the MDRs of education on access to unpaid and paid maternity leave among Black and Latino mothers compared to White mothers giving birth while living in poverty. Methods: We utilized baseline data from the Baby’s First Years Study (BFY), a longitudinal investigation of the effects of poverty on child development. The sample consisted of 1,050 mothers living in poverty who had recently given birth. Maternity leave (paid and unpaid) was assessed via self-report, and educational attainment was measured in years of schooling. Structural equation modeling (SEM) and interaction terms were employed to analyze racial and ethnic differences in the relationship between education and access to maternity leave. Results: Educational attainment was positively associated with access to unpaid maternity leave for the overall sample of mothers giving birth in poverty, but this association was weaker for Black and Latino mothers compared to non-Latino White mothers. Education did not significantly increase the likelihood of paid maternity leave, and there were no group differences for this association. Conclusion: This study highlights the urgent needs to address structural racism, labor market discrimination, and residential segregation that diminish the impact of education on living conditions for Black and Latino mothers, compared to non-Latino White mothers, even for those living under poverty. Policymakers and practitioners should develop targeted interventions to reduce racial and ethnic disparities in access to paid and unpaid maternity leave and other critical resources, particularly for new mothers living in poverty. Addressing these inequities is essential for improving maternal and newborn health outcomes and promoting social justice.

Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present) that start throughout pregnancy or during the first 4 weeks postpartum respectively: 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3) Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts; 7) Psychomotor excitation or delay. Perinatal depression carries vital and adverse consequences on mother’s psychosocial aspects of life, pregnancy and delivery outcomes, her interrelations specifically with the new born with poorer overall health and influences negatively on offspring from the intrauterine life passing by complicated delivery experiencing hard unstable childhood reaching unhealthy adolescence and adulthood. These negative consequences necessitate a great attention for prevention, screening and prompt treatment for antenatal and postnatal depression to prevent such disastrous effects.

The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.

The concept of maternity care satisfaction focuses on women's expectations and results in women having a positive attitude about the care received during pregnancy, childbirth and after birth. The proportion of births to Ghanaian migrant mothers in China is increasing, and there is an increasing demand for information regarding their reproductive health. To reduce maternal and neonatal morbidity and death rates, it is crucial for foreign women who use maternity services to be satisfied with their care. Ghanaian women's birth experiences in China might be harmed by language and cultural disparities. Little is known about their experiences in China's homogeneous society. A survey of 317 postnatal Ghanaian foreigners in Zhenjiang, China provided the study's data and was analyzed using IBM SPSS Statistics 25. The results showed that (76%) of postnatal foreigners were satisfied with delivery care. Though the satisfaction level was high, respondents raised the issues of poor communication (62.8%) and high cost of delivery care (52.4%) as some of the general experiences they faced. Healthcare providers’ strengthening routine monitoring of maternal and newborn health programs will help deliver more woman-centered care.

Women must be aware of the risk factors of pregnancy complications and the negative maternal and fetal health consequences to take preventative measures and management strategies that will result in a successful pregnancy. This study aimed to assess the Level of Knowledge about obstetric warning signs and the associated factors among pregnant Saudi women attending antenatal care in a tertiary care maternity set-up in Riyadh City. Data for this cross-sectional study were obtained using a structured questionnaire from eligible pregnant women admitted to King Saud Medical City (KSMC) between August 2020 and March 2021. Data were analyzed using descriptive and inferential statistics. Out of a minimum estimated sample size of 170, researchers recruited 362 participants. As observed, only 92 people, or 25.4%, had enough knowledge about various educational levels. The majority (91.2%) lived in villages, had no history of chronic disease (74.0%), and said that it took them at least 30 minutes to commute from their home to the hospital (69.3%). Two hundred two (55.7%) lacked appropriate knowledge, although most women (76.2%) had one to four pregnancies. Poor psychological health resulted from 37 people's (10.2%) inadequate Awareness. Even though 139 (38.4%) had spent more than 15 minutes receiving education from medical staff and 200 (61.5%) had attended the prenatal care clinic more than four times, most lacked adequate knowledge. The variables education level (P=0.000), working status (P=0.022), and place of residence (P=0.044) showed a statistically significant association with the knowledge level, also only education level statistically significantly affected the likelihood of knowledge gaps. In conclusion, early identification of obstetric warning signs and associated risk factors of pregnancy complications is integral to prevention.

Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

Meigs’ syndrome is a rare triad of a benign ovarian fibroma (or fibroma‑like tumor), ascites, and pleural effusion that resolves after tumor resection. A 53‑year‑old multiparous woman presented with progressive exertional dyspnea and right‑sided pleuritic chest pain. Respiratory and cardiac evaluations were initially unrevealing. Bedside assessment identified mild right basal dullness, and point‑of‑care abdominal ultrasound demonstrated mild free fluid and a solid right adnexal mass. Chest radiography confirmed a small right pleural effusion. Without computed tomography and without diagnostic paracentesis or thoracentesis, Meigs’ syndrome was suspected. The patient underwent laparotomy with total abdominal hysterectomy and bilateral salpingo‑oophorectomy. Histopathology confirmed an ovarian fibroma. Postoperatively, symptoms resolved dramatically, and follow‑up imaging demonstrated complete resolution of the pleural effusion and ascites. This case highlights the importance of considering gynecologic etiologies in unexplained pleural effusion and dyspnea, especially when accompanied by abdominal distension or pelvic pressure.

Introduction: Severe pre-eclampsia is a multisystem disorder associated with various ocular complications, however postpartum bilateral serous retinal detachment is uncommon and may threaten vision if not early recognized, thus requiring prompt management in order to prevent permanent visual loss. Clinical Description: A case of a 31-year-old woman, G3P0 with an in vitro fertilization and previous miscarriages, developed severe pre-eclampsia at 34 weeks of gestation. She underwent an emergency cesarean section for maternal indication. On the second postoperative day, she develops sudden unilateral blindness and blurred vision in the contralateral eye. Ophthalmological examination showed normal optics discs while MRI revealed bilateral serous retinal detachment. She was managed conservatively with strict blood pressure control, magnesium sulphate therapy and anticoagulation with full recovery of vision over 3 weeks without need of surgical intervention. Discussion: Postpartum retinal detachment is uncommon, most often serous and reversible. This case highlights that conservative management focusing on strict blood pressure control and supportive care was sufficient to avoid surgical intervention. Timely diagnosis and coordinated multidisciplinary management ensured complete visual recovery. Conclusion: Bilateral serous retinal detachment is a rare but reversible postpartum complication of severe pre-eclampsia. With early recognition, close monitoring and conservative management can lead to complete restoration of vision.

Introduction: Ovarian torsion is a rare gynecological emergency that can result in permanent ovarian loss if not promptly recognized and managed. Cases involving multiple rotations of the ovary are highly unusual and pose a significant risk for ovarian viability. Clinical Description: A 33-year-old P2 woman presented with sudden severe lower abdominal pain. Imaging showed a complex midline adnexal mass, more towards left and mild free fluid with suspected torsion. Emergency laparotomy showed a sixfold torsion of the right ovary with a dermoid cyst. Detorsion and cystectomy were performed with preservation of the ovary. Postoperative recovery was uneventful and histopathology further confirmed a benign dermoid cyst. Discussion: Ovarian torsion with multiple rotations is extremely rare so early recognition and timely surgical intervention enable ovarian salvage even in severe cases. Moreover, Dermoid cysts are the most common predisposing factor. Conclusion: This case highlights the importance of prompt diagnosis and immediate management of ovarian torsion to prevent complications, preserve ovarian integrity and fertility.

Wernicke’s encephalopathy (WE) is a neurological emergency related to a severe thiamine (vitamin B1) deficiency, an essential cofactor in cerebral energy metabolism. Although historically associated with chronic alcoholism, this condition can occur in any context of malnutrition, prolonged vomiting, or hypercatabolism. We conducted a retrospective descriptive study on seven patients admitted to our neurology department between 2015 and 2020, in order to de-scribe the clinical, radiological, and outcome characteristics of this pathology. The diagnosis was made in the presence of suggestive signs (at least two among confusion, ataxia, oculomotor disorders), a risk context of deficiency or malnutrition, typical MRI abnormalities and/or rapid improvement after thiamine ad-ministration. Our series included two male patients with chronic alcohol consumption, and five pregnant women with severe hyperemesis gravidarum, with an average age of 32.4 years. Mental confusion was the most frequent sign, followed by gait disturbances and oculomotor abnormalities. The most characteristic MRI lesions involved the thalamus, the periaqueductal region, and the mammillary bodies. All patients received high-dose intravenous thiamine supplementation (500 mg every eight hours for three days), followed by oral maintenance therapy. The outcome was favorable in five cases, while two patients had persistent memory disorders. These observations confirm that WE is not limited to alcoholic forms and must be considered in any situation with nutritional risk. Early diagnosis and rapid administration of intravenous thiamine remain essential to prevent irreversible neurological sequelae and improve functional prognosis.

Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. Clinical Description: A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. Conclusion: This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.

Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among families in poverty is crucial to designing equitable interventions. Objective: To examine racial and ethnic differences in baseline demographic, socioeconomic, health, and behavioral characteristics among families living in poverty, using data from the Baby's First Years (BFY:2018-2019) Study. Methods: This analysis used baseline data from the BFY study, a randomized controlled trial (RCT) designed to evaluate the effects of monthly cash assistance on children’s developmental outcomes. The sample included 1,050 children and their families, consisting of mothers and, when available, fathers. Descriptive analyses were conducted to compare demographic, socioeconomic, health, and behavioral outcomes across racial and ethnic groups, focusing on Black, Hispanic, and other mothers. Results: Significant racial and ethnic differences were observed. Regarding demographic factors, Hispanic mothers were older than White mothers. In terms of socioeconomic factors, Hispanic mothers had fewer years of education compared to White mothers, while Black mothers were more likely to receive food stamps than mothers from other groups. Regarding health and behaviors, Black mothers reported worse self-rated health but were less likely to plan for breastfeeding compared to White mothers. In contrast, Hispanic mothers reported lower levels of depression and were more likely to plan for breastfeeding. Conclusion: These findings highlight the heterogeneity of experiences among families living in poverty, with significant differences across racial and ethnic groups. Such disparities underscore the importance of tailoring anti-poverty policies to the unique needs of diverse populations. Future research should explore how the effects of interventions, such as cash assistance or guaranteed income, may differ across racial and ethnic groups to inform equitable and effective policy development.

This case report describes a postoperative complication following laparoscopic lateral suspen-sion with mesh for the treatment of pelvic organ prolapse (POP) in a 67-year-old woman. The pa-tient initially presented with grade III anterior vaginal prolapse and grade IV apical uterine pro-lapse. A laparoscopic lateral suspension procedure was successfully performed, and the patient was discharged on postoperative day two without complications. However, two weeks later, she experienced pelvic discomfort, and examination revealed a recurrence of the prolapse due to the failure of the right lateral arm of the mesh. The mesh was successfully reattached via a second laparoscopic procedure, and the patient had an uneventful recovery. This case highlights the po-tential for mesh dislocation postoperatively, underscoring the importance of secure mesh attach-ment to prevent recurrence of prolapse.

This integrative literature review aims to explore the pivotal role of dignity and respect in maternity care, focusing on their profound impact on the experiences of pregnant individuals. Emphasis is placed on cultural competence as a crucial factor in fostering understanding and respect for diverse backgrounds, promoting inclusive approaches to maternal care. The overarching goal is to underscore the significance of dignified and respectful care in enhancing maternal satisfaction, postpartum outcomes, and overall well-being. Methods: The review synthesizes existing literature (n=22) on maternity care, dignity, and respect, drawing insights from diverse sources to comprehensively analyze the multifaceted nature of this critical healthcare aspect. Cultural competence is explored as a key theme in understanding and appreciating the varied backgrounds of pregnant individuals. The analysis encompasses factors such as effective communication, healthcare provider attitudes, cultural competence, informed consent, and systemic considerations, shedding light on their collective influence on dignity and respect in maternity care. Principal Findings: The literature review reveals that providing dignified and respectful care significantly contributes to improving maternal satisfaction and postpartum outcomes. Cultural competence emerges as a crucial element, ensuring that care approaches are inclusive and tailored to diverse cultural backgrounds. Effective communication, positive healthcare provider attitudes, and considerations for systemic factors are identified as key determinants of the dignity and respect experienced by pregnant individuals. The findings underscore the interconnectedness of these factors in shaping the overall quality of maternity care. Practical Applications: Recommendations stemming from the literature review include interventions aimed at enhancing healthcare providers' communication skills, cultural competence training, and the promotion of patient-centered care models. Acknowledging the systemic factors influencing maternity care, the review calls for collaborative efforts among healthcare providers, policymakers, and researchers to create an environment that upholds pregnant individuals' autonomy and values. The practical applications emphasize the need for comprehensive and culturally sensitive approaches to ensure that all pregnant individuals receive dignified and respectful care. In summary, this integrative literature review provides a comprehensive understanding of the critical role of dignity and respect in maternity care, offering insights into effective strategies for improvement and emphasizing the importance of cultural competence and collaborative efforts in shaping the future of maternal healthcare.

Coronavirus infection (COVID-19) has quickly emerged as a global pandemic leading to critical health complications. The possibility and risk of vertical transmission of this virus is still unclear, particularly as it relates to pregnant women and their fetuses. Regarding scientific data, there is insufficient research focused on COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise. In this study, we report an intra uterus fetal death due to hydrops fetalis and twin-to-twin transfusion syndrome (TTTS) in monochorionic–monoamniotic (MCMA) twin pregnancy associated with mild COVID-19 infection in a 33-week-pregnant woman.

Caesarean section is the most common surgical procedure in obstetrics, but also in pregnant women with dystocia. The purpose of this study is to identify factors that contribute to post-caesarean complications in emergency of gynecology-obstetrics service of Saint Joseph Hospital in Kinshasa. This is a descriptive cross-sectional study and was conducted at Saint Joseph Hospital in Kinshasa city for a month (1^st and 30^th July 2021). A questionnaire was used to collect different data namely socio-demographic characteristics and different variables important for the study. Independent variables were factors related to the parturient and the current pregnancy, the surgical procedure and the operational room. While the dependent variable was post-caesarean complications in gynecology-obstetrics service. Descriptive statistical analyses namely frequency and percentage were done to describe the sample profile. To measure the strength of association between different variables were estimated using Pearson's Chi-Square (X²) test and the p-value was 0.05. Data analysis was performed using SPSS version 20 software. The majority of participants are over 33 years of age, have secondary school skills, married and have 3 to 4 children. It was observed that 88.2% of participants have acute respiratory distress prior to caesarean section, 76.6% have a personal history of thromboembolic disease prior to caesarean section. All the participants who underwent caesarean section were victims of external ventilation through the windows of the operating room, which remained open before, during and after the surgery and benefited from antibiotic treatment without any para-clinical analysis before the caesarean section. Furthermore, 82.4% of participants had benefited from the caesarean section with sterilized care materials 48 hours before and after the intervention. While 47.1% of participants had caesarean sections with defective equipment for the operation (use of dry heat sterilization etc.). A better identification of these risk factors can reduce significantly rate of complications and can consequently improve the maternal-infantile prognosis. The obstacles to effective management are related to the provision of quality services.

Introduction: One Key Question® is a patient-centered tool that seeks to understand patient pregnancy intention and counseling. This pilot study aimed to assess implementation of OKQ at an urban healthcare facility and improve understanding of short interpregnancy intervals (IPI). Methods: We describe the implementation of OKQ in our setting using the Diffusion of Innovation Theory as a framework. We broke this up into two phases – the first to assess provider acceptance of the OKQ integration into the clinic workflow and the second to assess how well documentation of OKQ answers occurred in our EMR. Results: Most providers in the first phase reported awareness of the inclusion of OKQ in the EHR, yet most physician providers reported only using OKQ at “some visits” (n=5) compared to the MAs, who reported using OKQ at “every visit” (n=8). Most providers felt that OKQ was an effective method of providing preconception and contraception care for women of reproductive age (n=10). Sixty-four patients completed a survey on OKQ after their visit who identified as young (mean age 28.7), either Black (46.9%) or Hispanic (51.6%) and pregnant (61%). Of those, 83% reported that they were not asked OKQ and 42% reported receiving counseling on optimal IPI. In those patients, 78% had documentation of usage of OKQ in the medical record. Discussion: The implementation of OKQ provided an opportunity to provide standardized preconception and contraception care to our patient population and improve information regarding short IPI. However, challenges existed in implementation which much be overcome to benefit from OKQ. Significance: OKQ has been used successfully in primary care and other settings to assess pregnancy intentions. This article adds to the literature by investigating the implementation of OKQ in a low-resource setting during prenatal and gynecology care. It shares struggles of implementing OKQ in an electronic medical record and how to roll out this program in a setting where pregnancy intention already is including in various forms by our providers.