Caroline A., 21

Caroline Atieno, born in 1999, lost her mother at a young age and was raised by her maternal grandmother. She completed Grade Eight but could not proceed to secondary school because of financial difficulties. At 16, while pregnant with her first child, she lost her grandmother and, with no reliable support or home, married partly to secure stability. Today, Caroline lives with her husband, children and extended family, including her parents-in-law, nieces and nephews. Her husband works as a sugarcane cutter, while Caroline earns small amounts by ploughing other people’s farms whenever work is available. During her twin pregnancy, Caroline presented to Awasi Catholic Mission Health Centre on 30 July at about 9:30 p.m. in active labour. She delivered the first twin vaginally, but the second twin failed to descend. Despite monitoring and supportive management, her uterine contractions gradually ceased, leaving the second baby retained for over two hours. This created an obstetric emergency, with increasing risk to both mother and baby. The clinical team therefore prepared Caroline for an emergency Caesarean section to safely deliver the second twin.

Caroline developed a retained second twin after successfully delivering the first twin vaginally, followed by cessation of uterine contractions and failure of the second baby to descend for over two hours. This was a significant obstetric emergency requiring prompt Caesarean delivery to reduce the risk of fetal hypoxia or death and maternal complications including haemorrhage and infection. With timely surgery, appropriate postoperative care and monitoring, Caroline’s prognosis is favourable, while the newborn requires careful assessment and observation.