OUTCOME OF LABOUR IN NULLIPARA AT TERM WITH UNENGAGED VERTEX
AbstractBackground: 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 vertex
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