OUTCOME OF LABOUR IN NULLIPARA AT TERM WITH UNENGAGED VERTEX
Abstract
Background: Primigravidas with unengaged foetal head at term should be regarded as high riskcases. It is seen that nuglliparous women with the floating foetal head demonstrate higher rates ofcaesarean section than those with dipping or engaged head in early labour. These cases should beregarded as high risk and identified early and should be referred to a tertiary care centre where goodfacilities for operative delivery are available. The present study was undertaken to determine theoutcome of labour in nulliparous women with unengaged head and compare it with those whopresent with engaged head at term as a case control study. The objective of the study was toenumerate the outcome of labour in nulliparous women presenting with unengaged head at term andcompare it with those who present with engaged head in early active labour. Methods: It was a casecontrol study, completed in 11 months, conducted in Department of Obstetrics and Gynaecology, SirGanga Ram Hospital, Lahore. 300 women were selected by convenience sampling. 150 nulliparouswomen who presented with unengaged head in early active labour were taken as cases, out which 2women left against medical advice with their medical records so data was missing leaving 148patients in this group. While 150 nulliparous women who presented with engaged head were taken ascontrols. Results: C-section rates was significantly found to be more in unengaged group being16.89%, compared with 5.33% in engaged group (p=0.000). Most of C-sections were carried out dueto failed progress of labour (48%). Patients with unengaged foetal head had significantly lowerAPGAR scores at 1 (p< 0.002) and 5 min (0.003) and higher mean birth weights (p= 0.002).Casesalso had significantly longer 1st (p=0.0001) and 2nd stage (p=0.004) of labour. Conclusion: Engagedvertex at the onset of active labour is associated with a lower risk of caesarean delivery in nulliparouswomen. Patients with unengaged vertex are at higher risk for caesarean delivery due to arrestdisorders. In addition to the higher caesarean rate patients with unengaged vertex are at risk ofhaving lower foetal APGAR scores and higher mean birth weights of newborns.Key words: labour outcome, nullipara, term pregnancy, unengaged vertexReferences
Qureshi NS, Saleem F, Riaz S. Primigravida with non engaged
foetal head at term: an audit of delivery outcome. Ann KE Med
Coll 1999;5:177–9.
Murphy K, Shah L, Cohen WR. Labour and delivery in
nulliparous women who present with an unengaged foetal head. J
Perinatal 1998;18:122–5.
Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap
LC, Hankins GDV, Clark SL. Williams Obstetrics. 20th ed.
Stanford: Connecticut: Appleton & Lange;1997.
Diegmann EK, Chez RA, Danclair WG. Station in early labour in
nulliparous women at term. J Nurse Midurifery 1995;40:382–5.
Shin KS, Brubaker KL, Ackerson LM. Risk of Cesarean
delivery in nulliparous women at greater than 41 weeks
gestational age with an unengaged vertex. Am J Obstet
Gynaecol 2004;190:129–34.
Falzone S, Chauhan SP, Mobley JA, Berg TG, Sherline DM,
Devoe LD. Unengaged Vertex in nulliparous women in active
labour. A risk factor for cesarean delivery. J Reprod Med
;43:676–80.
Wilkes PT, Wolf DM, Kronbach DW, Kunze N, Gibbas RS.
Risk factors for cesarean delivery at presentation of nulliparous
patients in labour. Obstet Gynecol 2003;102:1352–7.
American college of obstetricians and gynaecologists. Evaluation
of caesarean delivery. Washington DC: American college of
obstetricians and gynaecologists; 2000.
Lilford RJ, van Coeverden de Groot HA, Moore PJ, Bingham P.
The relative risks of caesarean section (intrapartum and elective)
and vaginal delivery:A detailed analysis to exclude the effects of
medical disorders and acute pre-existing physiological
disturbances. Br J Obstet Gynaecol 1990;97:883–92.
Gibbs RS. Clinical risk factors for puerperal infection. Obstet
Gynaecol 1980;55:178S–84S.
Roshan fekr D, Blakemore Kj, Lee j, Hueppchen NA, Witter FR.
Station at onset of active labour in nulliparous patients and risk of
cesarean delivery. Obstet Gynecol 1999;93:329–31.
Saropala N, Chaturachinda K. The relationship between head
level on admission and mode of delivery in primigravidae. J Med
Assoc Thai 1993;76:60–2.
Handa VL, Laros RK. Active – phase arrest in labour: predictors
of cesarean delivery in a nulliparous population. Obstet Gynecol
;81:758–763.
Debby A, Rotmensh S, Girtler O,Sadan O, Golan A, Glezerman
M.Clinical significance of floating foetal head in nulliparous
women in labour. J Reprod Med 2003;48:37–40.
Friedman EA, Sachtleben MR. Station of the foetal presenting
part II:Effect on course of labour. Am J Obstet Gynaecol
;93:530–6.
Takahasi K, Suzuki K. Incidence and significance of unengaged
foetal head in nulliparas I early labour. Int J Biol Res Pregnancy
;3(1):8–9.
Briggs ND. Engagement of the foetal head in negro primigravida.
Br J Obstet Gynecol 1981;88:1086–9.
Kushtagi P. Pattern of descent of foetal head in normal labour. J
Indian Med Assoc 1995;93:336–9.
Sheiner E, Levy A, Feinstein U, Hersh Kovitz R, Hallak M,
Mazor M. Obstetric risk factors for failure to progress in the first
versus the second stage of labour. J Maternal Neonatal Med
;11:49–13.
Friedman EA, Sachtleben. Station of the foetal presenting part.vi.
Arrest of descent in nulliparas. Obstet & Gynecol 1976;47:129–36.
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