Outcome of labour in nullipara at term with unengaged vertex

Primigravidas with unengaged foetal head at term should be regarded as high risk cases. It is seen that nuglliparous women with the floating foetal head demonstrate higher rates of caesarean section than those with dipping or engaged head in early labour. These cases should be regarded as high risk and identified early and should be referred to a tertiary care centre where good facilities for operative delivery are available. The present study was undertaken to determine the outcome of labour in nulliparous women with unengaged head and compare it with those who present with engaged head at term as a case control study. The objective of the study was to enumerate the outcome of labour in nulliparous women presenting with unengaged head at term and compare it with those who present with engaged head in early active labour.

It was a case control study, completed in 11 months, conducted in Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore. 300 women were selected by convenience sampling. 150 nulliparous women who presented with unengaged head in early active labour were taken as cases, out which 2 women left against medical advice with their medical records so data was missing leaving 148 patients in this group. While 150 nulliparous women who presented with engaged head were taken as controls.

C-section rates was significantly found to be more in unengaged group being 16.89%, compared with 5.33% in engaged group (p = 0.000). Most of C-sections were carried out due to failed progress of labour (48%). Patients with unengaged foetal head had significantly lower APGAR scores at 1 (p < 0.002) and 5 min (0.003) and higher mean birth weights (p = 0.002).Cases also had significantly longer 1st (p = 0.0001) and 2nd stage (p = 0.004) of labour.

Engaged vertex at the onset of active labour is associated with a lower risk of caesarean delivery in nulliparous women. Patients with unengaged vertex are at higher risk for caesarean delivery due to arrest disorders. In addition to the higher caesarean rate patients with unengaged vertex are at risk of having lower foetal APGAR scores and higher mean birth weights of newborns.