Hauwa A., 22

Hauwa Ali is a 22-year-old woman who lives in Karasauwa village. She is happily married to her husband, Musa, who is a local farmer. The couple lives a simple rural life, and Hauwa is a full-time housewife. Their household income is about 8,900 naira, which is mainly generated from Musa’s farming work. Due to this limited income, they often struggle to meet their basic needs and to access regular antenatal care during pregnancy, which contributed to the late presentation at the hospital when complications arose. Hauwa, a 22-year-old woman pregnant for the first time (primigravida), was admitted after experiencing labor pain for over 24 hours without progress. On examination and ultrasound, the doctors found that she is carrying twins at full term (39 weeks), the babies are in abnormal positions: One baby is lying transversely (sideways), while the second baby is in breech position (feet or buttocks first). Her cervix is already fully dilated, meaning labor has reached its final stage, despite this, delivery is not progressing, indicating an Obstructed and prolonged Labor which poses a great risk to the baby and mother.

The patient was admitted as an emergency case with a diagnosis of prolonged obstructed labour, characterized by failure of adequate progression of labour despite strong uterine contractions, associated with severe lower abdominal pain, maternal exhaustion, and signs of fetal distress. On admission, the patient was immediately assessed and resuscitated. A multidisciplinary obstetric team was involved, and urgent intervention was planned to prevent maternal and fetal complications such as uterine rupture, infection, and postpartum hemorrhage.. Management and Treatment Provided: IV fluids (Normal Saline/Ringer’s Lactate) for resuscitation and hydration IV broad-spectrum antibiotics (e.g., Ceftriaxone + Metronidazole) to prevent or treat infection IV analgesics (e.g., Paracetamol/Tramadol as appropriate) for pain control Urinary catheterization for monitoring urine output IV oxytocin (where appropriate and safe) for augmentation of labour Emergency Caesarean Section (LSCS) was performed due to failure of labour progression and fetal distress Spinal/General anesthesia was administered for surgical delivery Post-operative medications: IV antibiotics continued Oxytocin infusion to promote uterine contraction and reduce bleeding Analgesics (Paracetamol/NSAIDs) for pain control Iron and folic acid supplements to support recovery A live baby was safely delivered, and both mother and child were closely monitored in the postnatal ward. The mother showed good post-operative recovery with stable vital signs, well-contracted uterus, and no signs of hemorrhage or infection. She was later discharged home in stable condition with follow-up instructions.

Doctor’s Opinion Based on the clinical history, physical examination, and ultrasound findings, the patient is a 22-year-old unbooked primigravida at term with a twin gestation presenting with prolonged labour lasting over 24 hours. The absence of labour progression despite full cervical dilatation, combined with abnormal fetal presentations (transverse lie of the leading twin and breech presentation of the second twin), is consistent with prolonged obstructed labour. Additionally, evidence of foetal distress indicates that the intrauterine environment is no longer safe for the babies, likely due to compromised oxygen supply during the prolonged labour process. This situation constitutes an obstetric emergency requiring immediate intervention. Given these findings, vaginal delivery is not feasible or safe. Therefore, an emergency caesarean section (EMCS) is strongly indicated as the most appropriate and life-saving mode of delivery to prevent further maternal and fetal complications. Prognosis The prognosis in this case is guarded but favorable with prompt intervention. If the emergency caesarean section is carried out without delay, the chances of a successful outcome for both the mother and the babies are significantly improved. For the mother, early surgical intervention reduces the risk of serious complications such as uterine rupture, postpartum hemorrhage, and infection. For the babies, timely delivery increases the likelihood of survival and reduces the risk of birth asphyxia and long-term neurological damage. However, delays in intervention may worsen the prognosis, potentially leading to severe maternal morbidity or fetal loss. With appropriate surgical management and post-operative care, the overall outcome is expected to be good.