Published: 2019-03-26

Unengaged head at term in primigravida: does it affect the chance of having a normal delivery?

Sadiq Unnisa, Poornima M. S.


Background: In Obstetrics it is traditional concept that fetal head engagement occurs by 38 weeks in primigravida. Unengaged head in primigravida has been considered a possible sign of cephalo pelvic disproportion. It is associated with higher risk of cervical dystocia, which has led to increased rate of caesarean section with its financial implication and future restriction of family size. Labour is prolonged, the duration of both latent and active phase increases, due to improper fitting high fetal head.

Methods: The prospective descriptive study was conducted at the Yenepoya Medical College hospital OBG Department.  Study population included were 75 primi gravidas with unengaged head at term. Details of labour were noted down.  Augmentation was done with oxytocin and dose of oxytocin was titrated . CTG was used to monitor fetal heart.  Emergency LSCS was performed in patients with fetal distress or non-progress of labour.  In case of vagina delivery, duration of 1st and 2nd stage, APGAR score at 1 and 5 minutes, and birth weights were recorded.

Results: Of the 75 primigravida 66.66% were in the age group of 21-25yrs.  Majority of the women were of 39-40 weeks (42.66%) of gestation. Common causes of unengaged head was deflexed head in 15 (20%) CPD in 11 (14.66%), loops of cord around neck in 8 (10.66%), polyhydramnios in 2(2.66%), placenta previa type-I and II  : anterior in 5 (6.66%) 8 patients were with occipito posterior position.  No cause could be identified in 27 cases (36%). Vaginal delivery occurred in 68% and LSCS in 32%.

Conclusions: Unengaged head in primi gravida with spontaneous onset of labour is not an indication for LSCS. The attitude of watchful expectancy and timely intervention especially in those cases in which no significant etiological factor is found, the chances of vaginal birth increase there by reducing maternal land foetal morbidity.


Foetal, Maternal, Outcome, Primigravida, Unengaged fetal head

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Dwight JR, John ES. Normal labour, delivery, newborn care and puerperium. James RS, Ronald SG, Beth YK, Arthur FHD. Anforths obstetrics and gynecology. 9thed. Philadelphia: Lippincott Williams and Wilkins. 2003:53.

Ambwani B. Primigravidas with Floating Head at Term Or Onset Of Labor. The Internet Journal of Gynecology and Obstetrics. 2003.

Debby A, Rotmenseh S, Girtler O, Sadan O, Golan A,Glezerman M. Clinical significance of the floating head in nulliparous women in labour. J Reprod Med. 2003;48(1):37-40.

Yousuf R, Baloch SN. An audit of caesarean section. Park. J Med Res. 2006;45:28-31.

Shaikh F, Shaikh N. Outcome of primigravida with high head at term. J Pak Med Assoc. 2014;64(9):1012-4.

Mokasha FM .Comparison of pregnancy and labour in teen agers and primi gravida aged 21-25 years in Transkei. S Afr Med J. 1992;81(8):421-3.

Trevino TG, Puent GK. Indicationsfor caesarean section: Review of 300 cases. Ginecol Obstet Mex. 1998;66:411-3.

Shaikh F, Shaikh S, Shaikh N. Outcome of primigravida with high head at term. J Pak Med Assoc. 2014;64(9):1012-4.

Malik S, Asif U, Asif M. Primigravida; obstetrical outcome; with engaged versus unengaged fetal head with spontaneous onset of labour at term. Prof Med J. 2016;23(2).

A Shrivastava obstetrical outcomein primigravida with unengaged fetal head at spontaneous onset of labour at term gestation. IJSR 2017;6(8).

Saqib N, Saleem F, Saima R. Primigravidae with unengaged fetal head at term: an audit of delivery outcome. Ann King Edward Med Coll. 1999;5(2):177-9.

Dayal S, Dayal A, Outcome of labour in Nullipara at termwith unengaged vertex. Int J Med Res Rev.2014;2(2):130-13

Sudhir S, Mishra S., The outcome of labour in primigravida with term gestation and unengaged head at onset of labor-Indian J Obstet Gynecol Res. 2016;3(3):199-200.