Labour outcome in primigravida with unengaged head: a observational study

Authors

  • Anmol Dewan Department of Obstetrics and Gynaecology, HIMS, Jollygrant, Dehradun, Uttarakhand, India
  • Banishree Pati Department of Obstetrics and Gynaecology, HIMS, Jollygrant, Dehradun, Uttarakhand, India
  • Ruchira Nautiyal Department of Obstetrics and Gynaecology, HIMS, Jollygrant, Dehradun, Uttarakhand, India
  • Devnanda Chaudhary Department of Obstetrics and Gynaecology, HIMS, Jollygrant, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20220732

Keywords:

Primigravida, Unengaged head, Partograph, Labour, Caesrean section

Abstract

Background: Physiologically, labour is different in primigravida. It raises the apprehension of physicians. In the last two decades, the rising cesarean section rate is attributed to many factors, amongst which primigravida with the unengaged head is one of the significant cause. Objective were to study the labour outcome in a primigravida with unengaged head at term gestation in labour

Methods: An institution based prospective study was conducted among 120 subjects. Primigravida with unengaged head at term gestation at the onset of labour were included. Pregnancy with pathological conditions of the fetus and maternal co-morbid condition were excluded. Intrapartum monitoring was done, and the partograph was plotted.

Results: Amongst the study population, 49.2% (59) cases delivered by vaginal delivery. 58 (48.3%) cases were delivered by cesarean section.Non-progress of labour indicated cesarean delivery in most of the cases. In 34.4%of cases, non progress of labour was the indication for cesarean section. Duration of the first stage of labour ranges from 5-26 hours.

Conclusions: Primigravida with unengaged head at early labour is not a direct indication for cesarean section. Intrapartum monitoring and the art of instrumental delivery can result in successful vaginal delivery.

Author Biography

Banishree Pati, Department of Obstetrics and Gynaecology, HIMS, Jollygrant, Dehradun, Uttarakhand, India

Associate Professor

Department of Obstetrics & Gynaecology 

References

Trevathan W. Primate pelvic anatomy and implications for birth. Philos Trans R Soc B Biol Sci. 2015;12:21-9.

Bhadra DM, Sonawane PK. Comparative study between unengaged and engaged fetal head in primigravida at term or in labour. Int J Reproduct Contrac Obstetr Gynecol. 2018;7(11):4569-75.

Burkman RT. Danforths’s Obstetrics and Gynecology. JAMA. 2009;3:33-7.

Weeks ARL, Flynn MJ. Engagement of the fetal head in primigravidae and its relationship to duration of gestation and time of onset of labour. BJOG An Int J Obstet Gynaecol. 1975; 3:17-21.

Myerscough P. Caesarean section. In Munro Kerr's Operative Obstetrics. 10 ed. Bailliere Tindal. 1987: 295-316.

Abbaspour Z, Sabzezary F, Afshari P. The Correlation between Engagement Time of Fetal Head in Early Active Phase and Delivery Outcome in Primigravida Women. J Rafsanjan University Med Sci. 2005;4(4):326-41.

Debby A, Rotmensch S, Girtler O, Sadan O, Golan A, Glezerman M. Clinical significance of the floating fetal head in nulliparous women in labor. J Reprod Med Obstet Gynecol. 2003;6:34-41.

Jafarey SN. Maternal mortality in Pakistan-compilation of available data. J Pak Med Assoc. 2002;11:27-33.

Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep. 2017; 66(1):1.

Rhoades JS, Cahill AG. Defining and managing Normal and abnormal first stage of labor. Obstet Gynecol Clin N Am. 2017;44(4):535-45.

Pahwa S, Kaur A, Nagpal M. Obstetric outcome of floating head in primigravida at term. Int J Reproduct Contrac Obstetr Gynecol. 2018;7(1):242-8.

Chaudhary S, Farrukh R, Dar A, Humayun S. Outcome of labour in nullipara at term with unengaged vertex. J Ayub Med Coll Abbottabad. 2009; 3:25-9.

Sudhir S, Mishra S. The outcome of labour in primigravida with term gestation and unengaged head at onset of labour. Indian J Obstet Gynecol Res. 2016;3(3):199.

Iqbal S, Sumaira S. Outcome of primigravida with unengaged versus engaged fetal head at term of onset or labour. Biomedica. 2009;2:11-8.

Kang M, Kaur D. Effect of fatal station at the onset of labour on cervimetric progress in primigravida. J Obstetr Gynecol India. 2000;3:42-4.

Fielder M. Does presenting examination predict route of delivery in nulliparous term patients in spontaneous labor? Am J Obst Gynec. 1997;178:897.

Dayal S, Dayal A. Outcome of Labour in Nullipara at term with unengaged vertex. Int J Med Res Rev. 2014;2(2):130-4.

Joshi P, Kathaley M, Borade S, Dashrathi R. Maternal and Perinatal Outcome in Hypertensive Disorders of Pregnancy-A Retrospective Study. MVP J Med Sci. 2018;7:33-41.

Boyle A. Primary caesarean delivery in the United states. Obstet. Gynecol. 2013;122:33-40.

Mahajan N, Mustafa S, Tabassum S, Fareed P. Outcome of high fetal station in Primi-Gravida at term in labour. Int J Reproduct Contrac Obstetr Gynecol. 2016;5(3):873-8.

Downloads

Published

2022-03-25

Issue

Section

Original Research Articles