Kadija I., 25

Kadija is a 25-year-old woman who lives with her husband, Ali, in Gashua, Yobe State, Nigeria. They reside in a modest single-room mud house and face significant financial challenges in meeting their daily needs. Her husband works as a shoemaker, while Kadija supplements the family income through petty trading. Despite their hard work, their combined monthly income is only about ₦10,000, which is barely enough to provide food, shelter, and other basic necessities. As a result, the family has no savings to cover unexpected medical emergencies. Kadija was pregnant with twins in her second pregnancy. She presented to the hospital in active labour with severe abdominal pain after labour had continued for several hours without significant progress. She also noticed reduced fetal movements, raising concern for the well-being of her babies. On arrival, Kadija appeared exhausted and in severe distress. Obstetric examination and ultrasound assessment revealed a malpresentation in the twin pregnancy. In addition, fetal distress was detected, indicating that one or both babies were not receiving enough oxygen and were at immediate risk of serious complications or death if delivery was delayed. The combination of malpresentation in a twin pregnancy and fetal distress made her condition a life-threatening obstetric emergency. She was immediately admitted, for an emergency Caesarean section (C-section).

Kadija was admitted as an obstetric emergency and immediately assessed by the obstetric team. She was stabilized with intravenous fluids, oxygen therapy, and continuous monitoring of her vital signs and the fetal heart rates. Blood samples were taken for laboratory investigations, including a full blood count, blood grouping, and cross-matching in preparation for possible blood transfusion. After confirming the diagnosis of malpresentation in a twin gestation with fetal distress, she was prepared for an emergency Caesarean section (C-section). The surgery was successfully performed, and both babies were safely delivered. Following the operation, Kadija received comprehensive postoperative care, including intravenous antibiotics to prevent infection, pain management, uterotonic medications to promote uterine contraction and reduce the risk of postpartum hemorrhage, intravenous fluids for hydration, and close monitoring of her vital signs and surgical wound. The newborn twins were assessed by the neonatal team and monitored to ensure they adapted well after delivery. Medications administered included: Ceftriaxone 1 g IV once daily. Metronidazole 500 mg IV every 8 hours, followed by oral therapy. Oxytocin 10 IU IV/IM after delivery, followed by an infusion as indicated to prevent postpartum hemorrhage. Paracetamol 1 g orally or IV every 6–8 hours as needed for pain and fever. Diclofenac 75 mg IM or oral NSAIDs (if not contraindicated) for postoperative pain relief. Intravenous Normal Saline and Ringer's Lactate for hydration. Ferrous Sulphate 200 mg orally three times daily and Folic Acid 5 mg once daily to support recovery and correct postpartum anemia. Kadija recovered well after surgery. Her vital signs remained stable, her postoperative wound healed satisfactorily, and she was able to breastfeed and care for her babies. The twins remained stable under neonatal observation and showed good progress. She was discharged in good condition with medications, instructions on wound care, nutrition, personal hygiene, exclusive breastfeeding, family planning counseling, and scheduled postnatal follow-up visits. With continued adherence to treatment and follow-up, both Kadija and her babies are expected to make a full recovery.

Kadija is a 25-year-old Gravida 2 Para 1 (G2P1) with a twin gestation complicated by malpresentation and fetal distress. This is a high-risk obstetric emergency requiring immediate intervention. The abnormal fetal presentation made vaginal delivery unsafe, while the presence of fetal distress indicated that one or both babies were experiencing inadequate oxygen supply, placing them at imminent risk of birth asphyxia, permanent neurological injury, or death. The prognosis is good with timely emergency obstetric care and surgical intervention. The prognosis for the twins is also favorable, provided they continue to receive appropriate neonatal care and monitoring. However, if treatment had been delayed, the condition could have resulted in severe maternal complications such as postpartum hemorrhage, uterine rupture, infection, or even maternal death, as well as stillbirth, birth asphyxia, or neonatal death. Early intervention is therefore essential in saving the lives of both the mother and her babies.