<![CDATA[Background: Access to maternal health services in archipelagic regions remains challenging because geographic barriers can create systemic delays in care. Balobaloang Caddi Island, Pangkajene and Islands Regency, South Sulawesi, is served only by a village health post with limited basic emergency obstetric capacity, while the nearest primary healthcare facility with a sea ambulance is located on another island. Prolonged obstructed labor without timely intervention may result in severe perinatal complications, including intrauterine fetal death (IUFD). Case Presentation: A 33-year-old primigravida (G1P0A0) was referred from Balobaloang Caddi Island for obstructed labor after full cervical dilation had been present since 00:00 Central Indonesia Time without descent of the fetal head. Fetal heart tones were audible before departure but became undetectable during transfer. Referral by sea required approximately 14–20 hours depending on the vessel and weather. The patient arrived with IUFD. A maternity waiting home was available in the regency capital, but the patient had declined to use it for an unknown reason. Conclusion: This case illustrates all components of the Three Delays model, intensified by extreme geographic barriers and limited transport infrastructure. Strengthened antenatal risk assessment, inter-island referral systems, and effective use of maternity waiting homes are essential to reduce preventable perinatal loss in remote island communities.]]>
