AL. is a 32-year-old woman living in a remote village in rural Tanzania. She is pregnant with her fifth child, having experienced relatively uncomplicated pregnancies in the past. Her previous deliveries were all at home with the assistance of traditional birth attendants, as the nearest healthcare facility is over 50 kilometres away. She received minimal antenatal care during this pregnancy due to distance and cultural beliefs.

At 32 weeks of pregnancy, AL. suddenly developed severe vaginal bleeding. She also experienced sharp abdominal pain and dizziness. Her family initially tried traditional remedies, but as the bleeding continued, they decided to take her to the local health centre, which involved a long journey on foot and by bicycle.

AL.’s community has limited access to healthcare, and there is a strong reliance on traditional practices. Transportation is a significant challenge, and many women in the community give birth at home. AL.’s husband works as a farmer, and their economic situation makes it difficult to afford emergency medical care.

Upon arrival at the health centre, AL. was found to be pale, with a rapid pulse and low blood pressure, indicating significant blood loss. A physical examination revealed a tender abdomen and ongoing vaginal bleeding. The foetal heart rate was weak and irregular.

Given the urgency of the situation, an ultrasound was performed, which showed a placenta previa—where the placenta was covering the cervix. The condition was causing the severe antepartum haemorrhage. The foetus appeared to be in distress, and AL.’s condition was rapidly deteriorating.

The health centre lacked the resources to manage such a complex case, so AL. was urgently referred to the regional hospital. However, due to the long distance and the lack of an ambulance, there was a significant delay in her transfer. The medical team initiated IV fluids and attempted to stabilise her condition while arranging transport. Unfortunately, by the time AL. reached the regional hospital, she had lost a substantial amount of blood, and an emergency caesarean section was performed. The baby was delivered but did not survive due to prolonged distress.

She required a blood transfusion and intensive care due to the severity of her haemorrhage. She eventually recovered physically, but the loss of her baby had a profound impact on her mental health. This case highlights the challenges of managing antepartum haemorrhage in sub-Saharan Africa, where delays in accessing emergency care and limited healthcare infrastructure can lead to tragic outcomes.