Nancy A., 28

Nancy is a mother of three who lives with her husband and children in a two-room mud-walled house. Both she and her husband depend on subsistence farming and casual farm labor to support the family, making access to healthcare difficult due to limited income. Nancy developed pregnancy-induced hypertension and was later referred with obstructed labor. At Siaya County Referral Hospital unable to pay she was referred to Helpster program and underwent an emergency Caesarean section. Owing to the complexity of the case, a classical Caesarean section (a vertical incision on the upper uterus used when rapid delivery or difficult surgical access is required) was performed. During surgery, a rare heterotopic pregnancy was discovered, with the second fetus located in the pouch of Douglas. The placenta was found attached to the left ovarian artery, creating a high risk of catastrophic bleeding and making the operation technically demanding.

Nancy presented with a rare and extremely high-risk obstetric condition complicated by obstructed labour, pregnancy-induced hypertension, severe intraoperative bleeding, and postoperative wound complications. The complexity of the surgery required prompt multidisciplinary intervention, blood transfusion, and repeat surgery for wound closure. Although her recovery was prolonged, she responded well to treatment. With continued wound care, follow-up, nutritional support, blood level monitoring, and appropriate counseling regarding future pregnancies, her prognosis is favorable. Future pregnancies should be managed as high risk and delivered in a specialized referral facility.