Pregnancy in women over the age of 55 is exceedingly rare and poses major clinical challenges. With increasing access to assisted reproductive technologies (ART), more postmenopausal women are conceiving, often with donor oocytes. These pregnancies carry significantly increased maternal and fetal risk, especially when complicated by multiple gestation, prior uterine surgery, or chronic medical conditions such as hypertension¹.

This case highlights the obstetric and surgical management of a high-risk twin pregnancy in a 59-year-old woman, culminating in cesarean delivery complicated by abnormal placentation, subtotal hysterectomy, and a postoperative intra-abdominal haemorrhage requiring re-laparotomy.