Maryam A., 28

Maryam Adamu is a 28-year-old mother of one from Gashua. She began experiencing severe labor pains that lasted for about 8 hours, and because her husband, Musa, is a poor subsistence farmer and she also sells food to support the family, they struggle to meet their basic needs. The patient presented with an eight-hour history of severe abdominal pain and regular, painful contractions, noting a reduction in fetal movements for four hours. Physical examination and ultrasound findings revealed poor cervical progression, a leading twin in a transverse lie, and signs of fetal distress. Consequently, she was diagnosed with an obstructed twin labor and scheduled for urgent obstetric management.

Maryam managed as an emergency case of twin pregnancy in obstructed labor due to malpresentation of the leading twin (transverse lie) with suspected fetal distress. She was promptly admitted and prepared for emergency caesarean section after stabilization. Preoperative management included intravenous access, fluid resuscitation with normal saline, and routine pre-surgical investigations. Prophylactic antibiotics such as intravenous ceftriaxone were administered to reduce the risk of postoperative infection. Analgesia and antacid prophylaxis were also given as part of preoperative preparation. The patient had an uneventful postoperative recovery. She became Both babies were also managed and stabilized post-delivery with neonatal care support. The mother was later discharged in good condition with advice on wound care, medication adherence, and follow-up at the postnatal clinic.

Doctor’s Opinion: The patient is a twin pregnancy in active labor complicated by malpresentation of the leading twin (transverse lie) and a second twin in cephalic presentation. The condition has resulted in obstructed labor with poor progress of delivery and associated suspected fetal distress. Based on clinical assessment and ultrasound findings, spontaneous vaginal delivery is not feasible and poses significant risk to both the mother and the fetuses. The obstetric team recommends urgent surgical intervention (emergency caesarean section) to prevent further maternal and fetal compromise. Prognosis: The prognosis is guarded but favorable with prompt and appropriate intervention. Maternal outcome is expected to be good following timely surgical delivery and adequate postoperative care. However, fetal outcome depends on the duration and severity of distress prior to delivery. Early operative management significantly improves the chances of survival and reduces the risk of complications for both twins. Close monitoring is essential in the immediate postpartum period.