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 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. Methods: 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. Results: 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. Conclusion: 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.
Key words: labour outcome, nullipara, term pregnancy, unengaged vertex
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