TITLE:
Intrapartum Management of Severe Intellectual Disability with Acute Agitation Resulting in Successful Vaginal Delivery: A Case Report from a Resource-Limited Setting
AUTHORS:
Atta Owusu Junior, Yaw Gyanteh Owusu, Thelma S. Asare
KEYWORDS:
Intellectual Disability, Intrapartum Agitation, Labour, Vacuum-Assisted Delivery, Resource-Limited Setting, Shared Decision-Making, Maternal Health Equity
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.8,
August
25,
2026
ABSTRACT: Women with intellectual disabilities experience substantial inequities in maternity care and are more likely to undergo obstetric interventions because of communication barriers, behavioural challenges, and limited evidence to guide intrapartum management. We report the case of a primigravid woman in her late twenties with lifelong severe intellectual disability who lacked decision-making capacity and presented at 38+6 weeks’ gestation in latent labour with severe agitation that prevented safe obstetric assessment. Following unsuccessful non-pharmacological de-escalation, a single intramuscular dose of ketamine enabled urgent maternal and fetal assessment and multidisciplinary review. Formal capacity assessment confirmed the absence of decision-making capacity, and surrogate consent was obtained from her mother. After reassessment demonstrated no obstetric indication for Caesarean delivery, the multidisciplinary team revised the initial management plan in the patient’s best interests. Labour was expedited using vaginal misoprostol followed by oxytocin augmentation because of an unfavourable cervix, ineffective uterine activity, and recurrent agitation. Ongoing behavioural management was achieved with carefully titrated haloperidol and adjunctive promethazine under close maternal and fetal monitoring. Despite persistent communication difficulties and poor maternal expulsive effort, vacuum-assisted vaginal delivery resulted in favourable maternal and neonatal outcomes without respiratory compromise, extrapyramidal adverse effects, or other significant complications. This case demonstrates that severe intellectual disability and acute intrapartum agitation alone should not be considered indications for Caesarean delivery. With multidisciplinary collaboration, surrogate best-interest decision-making, appropriate pharmacological management, and vigilant intrapartum monitoring, safe vaginal birth may be achievable in carefully selected patients. Although a single case cannot establish safety or efficacy, it provides valuable insight into managing a complex clinical scenario for which evidence remains limited and highlights the need for further research and context-specific guidelines.