Mary O., 18

Mary is the last-born child in her family and lives with her parents, twin siblings, and nieces in a modest three-roomed mud-walled house. She is currently in Form Three and therefore depends entirely on her parents, who earn a living as charcoal vendors at the local market. Despite the family’s limited income, Mary is determined to complete her education and aspires to become a teacher in the future. Mary reports that she was initially unaware that she was pregnant. She had been experiencing frequent morning sickness, but it was her teachers who noticed the signs and advised her to take a pregnancy test. Although she initially dismissed their concerns, testing later confirmed that she was expectant. Her teachers offered counseling and encouraged her to continue attending school until delivery, reassuring her that she would be supported to resume her education afterward. She attended antenatal care (ANC) at a health facility near her school. During the school holidays, she visited her sister and continued her ANC at a nearby facility. During one of these visits, she was informed that one of the babies was not in the correct position and was referred to Siaya County Referral Hospital for further evaluation and management. Later, Mary developed abdominal pains at night. The following day, she presented to Siaya County Referral Hospital, where she went into active labour. She successfully delivered the first twin vaginally. However, after delivery, it was discovered that she was carrying a second twin in a breech position. The second baby could not be delivered safely through normal delivery and was retained in the uterus, posing significant risk to both mother and baby. Due to the retained second twin and the abnormal presentation, she was rushed for an emergency caesarean section to safely deliver the second baby and prevent life-threatening complications such as hemorrhage or fetal distress. While admitted at the hospital, a routine financial assessment was conducted. Mary and her family disclosed that they had no medical insurance and no means to settle the hospital bill, especially given the unexpected emergency surgery. During this time, they were informed about Helpster Charity through hospital staff. A social worker conducted a socioeconomic assessment and confirmed that the family qualified for support under the Helpster Charity program, enabling Mary to receive the necessary care without further financial burden.

Mary was taken for and emergency caesarean surgery after a retained twin. Her surgery was a success, post surgery she was admitted for management. She was administered IV plastic, oxytocin, 10% dextrose, brufen among other drugs. Ambulation was later encouraged and she was able to move around and even visit the NBu to feed her babies. She was later discharged on orals

Retention of the second twin after successful delivery of the first twin is an obstetric emergency. Once the second baby fails to descend - especially in cases of breech presentation or fetal malposition - the risk of fetal distress, cord prolapse, placental complications, and maternal hemorrhage increases significantly. In Mary’s case, the decision to proceed with an emergency caesarean section was medically appropriate and lifesaving. Prompt surgical intervention prevented prolonged fetal compromise and reduced the risk of severe maternal complications such as postpartum hemorrhage, uterine rupture, or infection. The prognosis of the second twin depends largely on: the duration between delivery of the first twin and surgical intervention, the presence or absence of fetal distress, the baby’s gestational age and birth weight When caesarean section is performed promptly, most retained second twins recover well without long-term complications. If oxygen deprivation was minimal and the baby was stabilized quickly after birth, the short-term prognosis is good. Mary's prognosis is equally good