DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221016

Maternal and neonatal outcome in primigravida with mobile head at ≥39 weeks of gestation

Sadhanadevi C., Sajini B., Acka Priya Varghese, Divya Sara Raju, Karishma Krishna Kurup

Abstract


Background: Primigravida with mobile head at ≥39 weeks of gestation are prone to the probability of caesarean section. With this study we aimed to identify the maternal and neonatal outcome of primigravida with mobile head at ≥39 weeks of gestation under the watchful expectancy and good conduct of labour.

Methods: A cross sectional study was conducted among primigravida with mobile head at ≥39 weeks admitted for delivery in the department of obstetrics and gynaecology, govt. medical college, Kottayam, Kerala, from February 2021 to September 2021. A sample size of 247 was identified considering 28% proportion of presentation with deflexed head, 95% confidence interval and 2% margin of error. A detailed history, physical examination and ultrasonography was performed.

Results: Of the 250 participants, the mean age of the study subjects was 24.97±3.93 and mean body mass index (BMI) was 23.72±4.78 kg/m2. The most common cause for mobile head was a deflexed head (35.2%). A lower segment caesarean section (LSCS) was conducted in 28.8% participants while vacuum assistance ad forceps assistance was required for 9.6% and 4.4% participants respectively. The most common indication for LSCSC being moderate to thick meconium-stained amniotic fluid (MSAF) 23% followed by 1st degree CPD failed trial in 17% cases. A significant association with maternal morbidity was observed in undiagnosed placenta previa (p=0.039) and vacuum-assisted deliveries (p=0.001). We observed that 3.6% of babies have meconium aspiration syndrome, and 8% of new born were admitted in intensive care for foetal distress.

Conclusions: Primigravida with mobile head at term during labour requires intense monitoring. Although the duration of labour appeared to be prolonged in a small proportion of patients with watchful expectancy and good conduct of labour and timely intervention, vaginal delivery is possible with minimal maternal and neonatal morbidity.

 


Keywords


Primigravida, Labour, Non engaged head

Full Text:

PDF

References


Segel SY, Carreño CA, Weiner SJ, Bloom SL, Spong CY, Varner MW et al. Relationship between fetal station and successful vaginal delivery in nulliparous women. Am J Perinatol. 2012;29(9):723-30.

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

Unnisa S, Poornima MS. Unengaged head at term in primigravida: does it affect the chance of having a normal delivery? Int J Reproduc Contracept Obstet Gynecol. 2019;8(4):1616-9.

Bibi S, Nasreen F, Habib S. Labour outcome in nulliparas with un-engaged fetal head at term pregnancy in Khyber teaching hospital, Peshawar. 2017;10(3):4.

Chaudhary S, Farrukh R, Dar A, Humayun S. Outcome of labour in nullipara at term with unengaged vertex. J Ayub Med Coll Abbottabad. 2009;21(3):131-4.

Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD et al. Contemporary Patterns of Spontaneous Labor with Normal Neonatal Outcomes. Obstet Gynecol. 2010;116(6):1281-7

Salim NA, Satti I, Mahmoud AO. Unengaged head in primigravidae, mode of delivery and outcome (a case-control study) in Dongola-Sudan. J Family Med Prim Care. 2021;10(3):1254-7.

Debby A, Rotmensch S, Girtler O, Sadan O, Golan A, Glezerman M. Clinical significance of the floating fetal head in nulliparous women in labor. J Reprod Med. 2003;48(1):37-40.

Sidhiq CM. Maternal and fetal outcome of Placenta Previa at a tertiary centre in North Kerala, India. Int J Reproduct Contracept Obstet Gynecol. 2018;7(5):1723-9.

Dwivedi S, Verma K, Jahan U, Malhotra V, Gupta S. Implications of placenta previa on pregnancy outcome: A prospective study. Indian J Reproduct Contracept Obstet Gynecol. 2020;5(1):91-7.




Bookmark and Share