Comparative study between unengaged and engaged fetal head in primigravida at term or in labour

Authors

  • Pundalik Krishna Sonawane Department of Obstetrics and Gynecology, K. J. Somaiya Medical college, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184509

Keywords:

Engaged, Lower segment caesarean section, Unengaged

Abstract

Background: The aim of the study is to compare and evaluate between unengaged (UE) and engaged (E) groups at term or in labour, incidence of unengaged and engaged heads, need for medical or surgical intervention, progress of labour and feto-maternal outcome.

Methods: It is a prospective comparative study carried at tertiary care hospital for a period of 18mths from May16-November17. Out of 377 patients, 100 patients were selected in each group with unengaged (group A) and engaged (group B) heads. Patients consent, and ethical approval was taken. History, examination and investigation was done at each visit. Incidence of unengaged heads at term or in labour, duration of each phase of labour and its partographic analysis, need for medical or surgical intervention, mode of delivery and fetomaternal outcome was calculated.

Results: Incidence of unengaged heads at term is 61%. 17% patients in unengaged group as compared to 10% required induction of labour while 73(73%) patients in unengaged group required augmentation with oxytocin as compared to 36(36%) patients in engaged group. Duration of labour in each phase was more in unengaged group. Incidence of lower segment caesarean section (LSCS) was 37% in unengaged group as compared to 23% in engaged group. Fetomaternal morbidity which was higher in unengaged was documented.

Conclusions: Although with unengaged head being a significant risk factor for LSCS, with watchful expectancy and careful intervention, most patients will deliver vaginally with minimal fetomaternal morbidity.

References

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilsirap LC III, Wenstroom KD. Williams Obstetrics. 22nd ed. Stanford, USA: Appleton and Lange; 1997. pp. 153-60,415-24,496-501.

Charles G Slipp. The primigravida in labour with high fetal station. Am J Obstet Gynecol. 1969;104(2):267-72.

Qureshi NS, Saleem F, Riaz S. Primigravida with non-engaged foetal head at term: an audit of delivery outcome. Ann King Edward Med Coll 1999;5(2):177-9.

Murphy K, Shah L, Cohen WR. Labour and delivery in nulliparous women who present with an unengaged foetal head. J Perinatol. 1998;18(2):122-5.

Friedman EA and Sachtleben MR.Station of fetal presenting, part-II, Effect on course of labour. Am J Obstet Gynecol 1965;93(4):530-55.

Thenmozhi RV. And Iyer L. Effect of engagement of head on labour. J Obstet Gynacol India. 1984;35(6): 1060-6.

Altman MR, Lydon‐Rochelle MT. Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth. 2006;33(4):315-22.

Daniel Roshanfeler, Karen J Blakenore, Judy LEE. Nancy A. Hueppcheu, Frank R. Witter. Station at onset of active labor in nulliparous patients and risk of cesarean delivery. Obstet and Gynecol 1999;93(3):329.

Chougtu L, Khanum W.. “Labour in primigravidae with unengaged heads”. J Obstet Gynacol India. 1977;27(4):329-32.

Lakshmidevi M, Malini KV, Shetty VH. Partographic analysis of spontaneous labour at term in primigravida. J Obstet Gynecol India. 2012;62(6):635-40.

Srivastava A. Obstetrical Outcome in Primigravida with Unengaged Fetal Head at Spontaneous Onset of Labour at Term Geastation. 2017;6(5):2618-23.

Malik S, Asif U, Asif M. Obstetical outcome of primigravida; engaged versus unengaged foetal head with spontaneous onset of labour at term. Professional Med J. 2016;23(2):171-5.

Iqbal S, Sumaira S. Outcome of primigravida with unengaged versus engaged fetal head at term or onset of labour. Biomedica. 2009;25:159-62 .

Shaikh F, Shaikh N, Shaikh N. Outcome of primigravida with high head at term. J Pak Med Assoc. 2014;64(9):1012-4.

Chaudhary S, Farrukh R, Dar A, Humayun S. Outcome of labour in nullipara at term with unengaged head. J Ayub Med Coll Abbottabad 2009;21(3):131-134.

Sunita S, Mishra S, The outcome of labour in primigravida with term gestation and unengaged head at onset of labour. Indian J Obstet Gynecol Res. 2016;3(3):199-20

Shivamurthy HM, Asaranna D, Giridhar SA, Jannu P, Jassawalla N, Himgire JR. Comparative study of labor course in primigravida with unengaged head in active labour, with those having engaged head. Medica Innovatica. 2014;3(2):84-9.

Mahajan N, Tabassum S, Fareed P. Outcome of high fetal station in Primi-Gravida at term in labour. Int J Reproduct, Contracep, Obstet Gynecol. 2017;5(3):873-7.

EL Nassery NS, EL Kattan EA, Fouad MA. Unengaged Head in Primigravidas, Will it Affect the Chance of Having a Vaginal Birth? Medical J Cairo University. 2013;81(2).

Dayal S, Dayal A. Outcome of Labour in Nullipara at term with unengaged vertex. Int J Medical Res Review. 2014;2(2):17-23.

Downloads

Published

2018-10-25

Issue

Section

Original Research Articles