Outcome of Labour in Nullipara at term with unengaged vertex

Abstract

Introduction: Engagement of head is most important event in labour which decides obstetric and neonatal outcome. Primigravida is considering important obstetric risk factor. Similarly unengaged head at term should be regarded as high risk case. Present study was conducted to determine the outcome of labour in nulliparous with unengaged head.

Methods: It was a case control study conducted in teaching hospital of central India. In the study period, 442 booked cases were studied, among which 214 cases were primigravidae (cases) and 228 cases were multigravidae.

Results: In the present study, among primigravidae 189 (88.31 %) cases were unengaged at the onset of early labour. In the present study 155(72.42 %) cases presented at -3 station at the onset of labour. Most of them (85 %) delivered by Normal delivery. when engagement occurred at the onset of early labour 92 % of patients delivered by normal delivery. When head did not engaged almost 22 % of deliveries required instrumental or operative procedures. Mean birth weight was 2.065 in engaged group while 2.77 in unengaged group.

Conclusion: In nulliparous patients a high station at the onset of labour is not necessarily an omnious finding, even though the incidence of arrest disorders are higher when station is -3,or floating ,obstetricians can still be optimistic towards vaginal delivery.