DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193106

Maternal outcome of primigravida patient with term pregnancy with engaged versus unengaged foetal head at onset of labour

Aditi Goyal, Rekha Wadhwani

Abstract


Background: The primigravida are a group at risk as their capacity of child bearing has never put to the test, “primigravida is a dark and untired horse". The potential for future child bearing is determined by outcome of first labour. Hence, if first pregnancy results in normal healthy child, patient is mentally better prepared for subsequent pregnancies. Foetal head is said to be engaged when its biparietal diameter, the greatest diameter in an occiput presentation, passes through the pelvic inlet. Unengagement of head in primigravida has long been considered a possible sign of cephalopelvic disproportion.

Methods: The study had 220 primigravida of which 110 had unengaged head as study group and 110 engaged head as controls. Data collection was done and the course of labour in all the patients recorded on partograph and all the patients were studied in detail. Engagement of the head was defined on the basis of Second Pawlik’s grip and Crichton’s fifth’s formula.

Results: Our study shows that higher age group had more number of cases with unengaged head. The patient with engaged head had higher number of vaginal delivery than study group with unengaged head. More number of LSCS i.e. about 39.1% in study group as compared to 21% of controls is statistically significant difference (p value 0.05).

Conclusions: We can conclude that primigravida with unengaged foetal head at onset of labour may deliver vaginally with minimal maternal morbidity, if proper   monitoring and maintenance of partogram is done.


Keywords


Engaged, Foetal head, Labour, Primigravida, Term pregnancy, Unengaged

Full Text:

PDF

References


Romero Ian Donald’s Practical obstetric problems, seventh edition; 2014:465.

Ambwani BM. Primigravida with floating head at term or onset of labour. Int J Gynaecol Obstet. 2004;3(1):1.

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

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

Jafarey SN. Maternal mortality in Pakistan compilation of available data. J Pak Med Assoc. 2002;52:539-54.

Macara LM, Murphy KW. The contribution of dystocia to caesarean. Am J Obstet Gynecol. 1994;171(1):71-7.

Iqbal S, Sumaira S. Outcome of primigravida with unengaged versus engaged foetal head at term or onset of labour. Biomed. 2009;2:159-62.

Prameela MG. Outcome of unengaged head in primigravida at term at onset of labour. Int J Recent Trends Sci Tech, 2014;1(2):345-9.

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

Pahwa S, Kaur A, Nagpal M. Obstetric outcome of floating head in primigravida at term. Int J Reprod Contracept Obstet Gynecol. 2018 ;7(1):242-24.