Engagement of the fetal head in the negro primigravida

A prospective study into causes of non-engagement of the fetal head at term in the negroid primigravida showed no correlation with fetal birth weight nor with the pelvic brim inclination. However, there was a significant difference (p less than 0.05) between the mean head circumference of babies with heads which had not engaged (34.1 cm) and with those which had (33.1 cm). Labour was generally prolonged with a high head at term, but there was no increase in the incidence of fetal or maternal mortality and morbidity nor was it associated with an increase in the rate of operative interference. In addition, retrospective studies on pelvic brim inclination between 31 Nigerian primiparae and matched Caucasians at the Queen Charlotte's Maternity Hospital showed no statistically significant differences. It is suggested that an unengaged fetal head in early labour should not by itself be an indication for early delivery by caesarean section.