Maimuna B., 23

Maimuna is a young woman from Gaidam village who lives in extreme hardship. She is physically disabled and depends entirely on her husband for mobility and daily care. Her husband is a subsistence farmer, and together they survive on a very small income of about ₦5,500. They live in a single-room mud house with limited access to basic amenities and healthcare. Maimuna a 23-year-old woman at full-term pregnancy, she was rush to Ayaji Hospital with prolonged labor, lower abdominal pain, back pain, and vaginal discharge. She first sought care at a peripheral health facility, but there was no progress in labor and her condition worsened. On presentation to the hospital, further evaluation confirmed a diagnosis of prolonged obstructed labor with foetal distress, delivery was not progressing and the fetus was in danger. Ultrasound scan, confirmed a ruptured uterus with significant internal bleeding (hemoperitoneum). Her clinical condition was further compromised by hypotension (BP 90/60 mmHg) and severe anaemia (PCV 17%). Final Diagnosis: Ruptured uterus complicated by prolonged obstructed labor, fetal distress, antepartum haemorrhage (APH), hemoperitoneum, and severe anaemia.

Maimuna On arrival, was critically ill and immediately resuscitated with oxygen, IV fluids, and blood transfusion. She was started on IV antibiotics (Ceftriaxone, Metronidazole, Gentamicin) and analgesics. She underwent emergency laparotomy for ruptured uterus with delivery of the baby and control of bleeding. The uterus was repaired and the abdomen cleaned. Post-operatively, she received continued antibiotics, IV fluids, blood transfusion, oxytocin, and iron supplements. Her condition improved steadily, vital signs stabilized, and she was discharged in stable condition with follow-up advice.

The condition is a life-threatening ruptured uterus due to prolonged obstructed labor with foetal distress. Complications - hypovolemic shock, severe sepsis from intra-abdominal contamination, and acute multi-organ failure, which carry an extremely high risk of maternal and fetal mortality without immediate surgical intervention and massive blood transfusions. It requires immediate resuscitation and emergency surgery (laparotomy with delivery and uterine repair or hysterectomy). Any delay increases the risk of maternal shock and death. Prognosis: Guarded. Maternal survival depends on rapid intervention, blood transfusion, and postoperative care, though complications may occur. Fetal prognosis is poor due to distress and delayed treatment.