Maryam Z., 28

Maryam is a 28-year-old housewife and mother of six living with her family in Yobe State. They reside in a one-room cement house with zinc roofing. Her husband works as a labourer, earning approximately ₦7,000 monthly. The family has access to a well and electricity but faces financial hardship. Following a rapid labour and unattended delivery, Maryam developed profuse vaginal bleeding, dizziness, and generalized weakness. She was rushed to the hospital for emergency care. Examination revealed severe bleeding, an atonic uterus, pallor, a pulse of 110 beats/min, and blood pressure of 80/60 mmHg. She was diagnosed with severe postpartum haemorrhage due to uterine atony, complicated by hypovolaemic shock, requiring urgent treatment to control bleeding and stabilize her condition.

Maryam was treated urgently for postpartum haemorrhage and shock. IM oxytocin 10 unit was given to promote uterine contraction and control the bleeding. She received 1 litre of intravenous normal saline over one hour, after which her blood sugar reduced to 13 mmol/L, pulse improved to 80/min and blood pressure to 90/60 mmHg. A further 1 litre of normal saline was administered. Blood transfusion was planned because of the significant blood loss and PCV of 20%, but Maryam declined transfusion. She was therefore managed with haematinics, including folic acid and fersolate, together with continued clinical monitoring and supportive care. Following treatment, Maryam's haemodynamic condition improved, with reduction in her pulse rate and improvement in blood pressure. The acute bleeding was brought under control and she remained clinically stable during observation. She was discharged two days after presentation with continued haematinic therapy and follow-up advice. Her follow-up appointment was scheduled for one month, taking into consideration the considerable distance between her residence and the hospital.

Maryam presented with a potentially life-threatening obstetric emergency involving severe postpartum haemorrhage and circulatory shock. Her low PCV of 20% indicates significant blood loss and anaemia. Blood transfusion was recommended but declined by the patient. If left untreated, severe postpartum haemorrhage can lead to worsening shock, organ damage, and potentially death. Her immediate condition improved following uterotonic treatment, intravenous fluid resuscitation and supportive management. The immediate prognosis is guarded but improved following stabilization. Continued follow-up is important to monitor recovery from anaemia and ensure appropriate postpartum care.