Obstetric Outcome in Primigravida with Unengaged Fetal Head at term: A Prospective, Observational Study

The presence of an unengaged fetal head at term in primigravidae is often viewed with apprehension due to its association with cephalopelvic disproportion, prolonged labor, and increased operative intervention. This study aimed to evaluate obstetric dynamics, mode of delivery, and perinatal outcomes in primigravida women presenting with an unengaged fetal head at the onset of labor compared with those having an engaged head.

This prospective, descriptive study was conducted in the department of obstetrics and gynecology at a tertiary care teaching hospital in India. A total of 86 primigravidae at term were enrolled and equally divided into two groups: 43 with an engaged fetal head (control group) and 43 with an unengaged fetal head (study group). Labor progress was monitored using a partogram. Maternal outcomes (duration of labor, mode of delivery, and blood loss) and neonatal outcomes (Apgar scores and NICU admission) were compared between the groups.

The unengaged group had a significantly longer duration of labor (14.40 ± 1.76 h) than the engaged group (11.19 ± 2.57 h; P < 0.001). Although the lower-segment cesarean sections rate was higher in the unengaged group (60.5% vs. 53.5%), this was not statistically significant (P = 0.514). Neonatal morbidity was significantly higher, with increased NICU admissions (23.3% vs. 7.0%; P = 0.035) and lower 5-min Apgar scores.

An unengaged fetal head at term is a risk factor for prolonged labor and increased neonatal morbidity but is not an absolute indication for cesarean section. Watchful expectancy with vigilant intrapartum monitoring can optimize the outcomes.