Agnes N., 20

Agness, a 20-year-old from a rural area, comes from a family that often has to walk long distances to access water and firewood. The household relies on a pit latrine for sanitation and depends on their mother as the sole breadwinner. Her mother earns no more than KSh 150 per day from hawking second-hand clothes, an income insufficient to meet the family’s basic needs. Agness dropped out of secondary school due to lack of school fees and other necessities, such as stationery. She is a hardworking young woman with aspirations of becoming a leading businesswoman. Agnes was referred from a nearby sub-county hospital while in labor, presenting with lower abdominal pain and severe backache that had been increasing in both frequency and intensity. On examination, she was diagnosed with prolonged labor due to cephalopelvic disproportion, with poor progress at 4 cm cervical dilatation. She had been monitored at the previous facility that referred her to our hospital for 24hrs but there was very poor progress. At Kory, cervical dilation was at 4 cm and had remained unchanged for over 8 hours, with the fetal head still high and no evidence of descent even after being given medication to enhance the contractions. According to the partograph, the labour had crossed the action line, necessitating urgent intervention. Diagnosis of cephalopelvic disproportion usually arises during active labor, when there is adequate uterine contractions but the fetal head fails to descend, and cervical dilatation either progresses very slowly or stalls. Given this complication, a normal delivery would be extremely risky and potentially impossible.

Agnes was referred from a nearby sub-County hospital with complains of lower abdominal pain associated with backache that is increasing frequency and intensity. On examination Fundal height was 38/40, FHR-present at 95bpm, longitudinal lie, cephalic presentation, she had been 4 cm cervical dilated for over 12 hours with high fetal station at the subcounty hospital and confirmed the same findings at our facility. She was diagnosed with prolonged labor due to cephalopelvic disproportion and fetal distress, complications which are dangerous or even impossible to wait and opt for a spontaneous vertex delivery. Therefore a caeserian section was done to save lives of mother and the baby. The operation was successful both mother and the baby were in stable condition and discharged.

Agnes's prognosis is excellent. Both her and the baby are doing well, following the successful emergency ceaserian section. With follow -up, rest and close motoring she is expected to fully recovered with no any complications. Offering physical and sycho-social support will help smooth recovery and to take good care of her Baby.