Doreen N., 20

Doreen comes from a very poor background. She dropped out of school in Form Two after losing both parents - her father died five years ago, and her mother passed away when she was 15, leaving her completely orphaned. She now lives with her aunt, who has seven children. The entire household shares a single-room home. Her aunt’s husband abandoned the family after struggling to find employment, and her aunt now walks long distances each day to work as a housemaid. The little income she earns can barely provide even one meal a day, and she is unable to pay school fees for any of the children. Doreen was admitted to the with a one-day history of lower abdominal pain radiating to the back. On admission, she was in fair condition, with blood pressure of 141/70 mmHg, pulse rate of 76 bpm, and temperature of 36.4°C. Abdominal examination revealed a term pregnancy. She was admitted for routine labor monitoring and encouraged to walk around to promote labor progression. At the first 4-hour review, contractions had not changed, and cervical dilation had not increased. A membrane sweep and amniotomy were performed, releasing clear liquor. Doreen continued to ambulate, and although contractions became stronger and more frequent, but the cervix at the 8-, 12-, and 16-hour assessments. Fetal heart rate remained stable throughout. Doreen started showing signs of exhaustion - severe pain, sweating, and fatigue. Examination revealed the presenting part still high and a caput ++. After several hours of labor, during the doctor’s ward round, moulding of the fetal head was observed, indicating prolonged and obstructed labor due to cephalopelvic disproportion (CPD). It was determined that a vaginal delivery was not possible, and an emergency cesarean section was recommended. Doreen became too weak after operation a day after she developed abdominal distension and vomiting, probably from partially handling the intestines during the caeserean section. The surgical team reviewed her and diagnosed postoperative ileus, likely related to bowel manipulation during the procedure. She was kept nil per oral (NPO) for an extended period to allow bowel function to recover. The ileus gradually resolved with conservative management. This complication contributed to delayed initiation of breastfeeding, as she remained unable to feed comfortably during the early postoperative period.

Doreen came to the facility in labour accompanied by her mother with complains of severe lower abdominal pain radiating to the back with cervical dilatation at 6cm without any progress for several hours. On examination she was diagnosed with prolonged labour due to cephalopelvic disproportion, the medical team recommended for emergency ceaserian section to be contacted immediately for the purpose of saving lives of mother and the baby. The operation was successful both mother and the baby were in good condition and discharged on a stable condition.

Prognosis is good, the CPD was recognized early and managed appropriately through a caeserean section and the outcome is generally good for both the mother and the baby. However, if the condition is not detected or treated on time, it can lead to serious complications such as fetal distress, uterine rupture, infection, or stillbirth, and the mother may experience excessive bleeding or exhaustion. With timely medical intervention, full recovery is expected. Additionally, the outlook for postoperative ileus is generally very good. In most cases, it is temporary and resolves on its own with supportive care such as rest, fluids, and keeping the patient off food for a short period. Once the intestines “wake up” and start working again, patients usually recover fully without any long-term problems which was the case for Doreen.