Maurine K., 19

Maurine is a young woman from a severely disadvantaged socio-economic background, living in conditions of profound poverty. Throughout her pregnancy, she encountered numerous challenges, including inadequate nutrition, limited access to antenatal care, and lack of transport to health facilities. Financial hardship prevented her from attending regular clinic appointments and receiving consistent medical follow-up, placing both her and her unborn baby at increased risk. When Maurine went into labour, her condition quickly became critical. After labouring at home for approximately 24 hours without progress, concerned well-wishers and community members rushed her to the hospital. Upon arrival, it became evident that she was unable to meet the required hospital expenses, including admission fees, delivery costs, medications, and essential supplies. The financial burden compounded the emotional and physical stress she was already enduring during this life-threatening situation. Maurine, a primigravida at term, presented with severe lower abdominal and lower back pain, reporting persistent strong contractions without delivery. She described increasing abdominal distension, reduced urine output, and profound exhaustion. Her membranes had ruptured several hours prior to presentation, but there was no history of vaginal bleeding. On general examination, she appeared anxious, fatigued, and in significant painful distress. She was mildly dehydrated. Her vital signs showed a temperature of 37.8°C, pulse rate of 118 beats per minute (tachycardic), blood pressure of 100/65 mmHg, respiratory rate of 24 breaths per minute, and oxygen saturation of 97% on room air. Dry mucous membranes and suprapubic fullness suggested dehydration and a distended bladder. Abdominal examination revealed a term gravid uterus with strong, frequent contractions occurring every 2–3 minutes and lasting about 60 seconds. There was notable tenderness over the lower uterine segment. The fetus was in a longitudinal lie with cephalic presentation; however, the presenting part remained high and poorly engaged despite adequate contractions. The fetal heart rate was 168 beats per minute, indicating fetal tachycardia and possible compromise. On vaginal examination, the cervix was 9 cm dilated and fully effaced. There was marked caput succedaneum and significant moulding (+++). Despite effective uterine contractions, the fetal head remained at –2 station. Clinical pelvic assessment revealed features suggestive of cephalopelvic disproportion, including a prominent sacral promontory and reduced pelvic capacity. The membranes were absent, and meconium-stained liquor was noted. A diagnosis of obstructed labour secondary to cephalopelvic disproportion, with impending fetal compromise, was made. Given the severity of the situation and the risk to both mother and baby, an emergency caesarean section was performed.

Maurine was brought to the hospital by well-wishers after labouring at home for approximately 24 hours without progress. She complained of severe lower abdominal pain, lower back pain, and inability to deliver despite strong, frequent uterine contractions. She reported progressive abdominal distension, minimal urine output, and increasing exhaustion. On vaginal examination, the cervix was 9 cm dilated and fully effaced. There was significant caput succedaneum and pronounced moulding (+++). The fetal head remained high at –2 station despite adequate uterine contractions. The pelvis was clinically assessed to be inadequate, with a prominent sacral promontory and reduced pelvic capacity, consistent with cephalopelvic disproportion (CPD). The membranes were absent, and the liquor was meconium-stained. A diagnosis of obstructed labour secondary to cephalopelvic disproportion with impending fetal compromise was made. An emergency caesarean section was performed. A live neonate was delivered with Apgar scores of 6 at 1 minute and 8 at 5 minutes. The baby required brief resuscitative support and was subsequently monitored in the newborn unit. She responded positively to medication and discharged home when stabilized and in good condition.

The postoperative course for both mother and baby was favorable. Maurine should recover well, with stable vital signs, adequate urine output, good wound healing, and no evidence of postoperative complications. The neonate should maintain stable cardiorespiratory status, tolerate feeds, and demonstrated appropriate clinical progress. Overall, the prognosis for both mother and baby is good