The original study analysed systemic challenges in obstetric and gynaecological medicine in a West African nation. This replication study verifies and updates those findings within Guinea, assessing whether previously identified issues persist, have evolved, or if new ones have emerged. The primary purpose was to replicate the methodological approach of the foundational study within Guinea. Objectives were to: 1) identify prevailing challenges in obstetric and gynaecological service delivery; 2) analyse key barriers to accessing maternal healthcare; and 3) compare the current landscape with the historical baseline from the original research. This qualitative, descriptive case study followed a replication protocol. Data were collected via semi-structured interviews with healthcare professionals and focus group discussions with service users. Documentary analysis of facility records and policy documents was also conducted. Thematic analysis identified recurrent challenges. Critical challenges in infrastructure, drug supply, and specialist staffing persist. A significant proportion of clinicians cited stock-outs of essential uterotonics and antibiotics as a weekly or more frequent occurrence, severely impacting emergency care. Newer challenges related to digital health integration and managing patient expectations were also identified. The replication confirms the enduring nature of fundamental systemic challenges within Guinea's obstetric and gynaecological services, while also highlighting evolving pressures. This suggests core issues require sustained investment, and health system planning must adapt to contemporary demands. Immediate recommendations include strengthening national supply chain mechanisms for essential medicines. Long-term recommendations focus on increasing the specialist workforce through targeted training and developing context-appropriate digital health strategies. Replication study, maternal health, healthcare access, health systems, Guinea This study provides a contemporary verification of persistent and emerging systemic challenges in obstetric and gynaecological care in Guinea, offering evidence to inform targeted health system strengthening.