Hadiza M., 30

Hadiza is a 30-year-old woman from Gashua, living under difficult economic conditions with a monthly household income of about ₦8,000. Despite the challenges of her environment, she remains resilient and committed to caring for her family, holding on to hope for a better future. At 35 weeks of pregnancy with twins, she had a home delivery of the first baby but developed complications with the second twin. She presented with a retained second twin in an abnormal position (hand prolapse) and absence of fetal movement for several hours, indicating a serious obstetric emergency. She was diagnosed with a retained second twin complicated by intrauterine fetal death. An emergency cesarean section was performed to safely deliver the second twin and placenta, preventing life-threatening complications. She is currently recovering following the procedure.

During the surgical procedure, the retained second twin was carefully and successfully delivered through emergency Caesarean section. The uterus was thoroughly examined, and appropriate measures, including administration of oxytocin and other uterotonic agents, were taken to ensure adequate uterine contraction and control bleeding. The operation was completed successfully without any intraoperative complications. Following surgery, the patient was closely monitored in the recovery ward and remained hemodynamically stable, with satisfactory vital signs throughout the postoperative period. She received broad-spectrum antibiotics to prevent infection, analgesics for pain management, intravenous fluids for hydration, hematinics to support recovery, and other supportive medications as required. The surgical wound healed progressively, with no evidence of infection, sepsis, or excessive postoperative bleeding. The patient demonstrated steady clinical improvement during her hospital stay. She tolerated oral feeding well, gradually resumed ambulation, and regained her strength. In addition to medical treatment, emotional and psychological support was provided to help her cope with the loss associated with the intrauterine fetal death of one twin. Overall, the patient responded well to treatment and recovered satisfactorily. She was discharged home in stable condition with prescribed medications, counseling, and appropriate follow-up care instructions.

Hadiza presented with a retained second twin in transverse lie with hand prolapse and confirmed fetal demise, creating a critical situation where vaginal delivery posed a high risk of uterine rupture. The priority was immediate surgical intervention to prevent maternal complications such as hemorrhage, sepsis, and coagulopathy. The prognosis depends largely on the timeliness of intervention. With the cesarean section already performed, her outlook is cautiously favorable, with recovery expected if postoperative care is adequate. The focus remains on preserving her health and future fertility.