Esther Adongo O., 27

Esther is a young mother of four who left school in Class Six. She lives with her spouse and children in a single-room mud-walled house. With no employment of her own, she depends on her spouse, who survives on irregular menial jobs. She hopes to one day establish a small grocery stall to supplement the family income. Esther discovered her pregnancy during a health facility visit and subsequently attended seven ANC visits, walking over 40 minutes each way. Having delivered her previous child by Caesarean section, she required careful monitoring. At about eight months, Esther suddenly developed painless vaginal bleeding, with blood trickling down her legs. She was rushed to a nearby health centre and urgently referred to Siaya County Referral Hospital. Specialist assessment revealed a twin pregnancy with Grade III placenta previa, where the placenta significantly covers the cervical opening. Combined with her previous Caesarean scar, this created a very high-risk obstetric situation with the potential for severe maternal haemorrhage and fetal compromise. An emergency Caesarean section was therefore performed to protect Esther and her babies.

Esther’s Grade III placenta previa with twins and a previous Caesarean scar made vaginal delivery unsafe. Labour could provoke severe or uncontrollable haemorrhage, fetal distress, shock and potentially maternal or fetal death. Caesarean delivery was therefore medically indicated. With the timely surgery, adequate blood-loss management and appropriate postoperative monitoring, her prognosis is favourable.