RESUMEN
Background: The primigravida are a group at risk as their capacity of child bearing has never put to the test, “primigravida is a dark and untired horse". The potential for future child bearing is determined by outcome of first labour. Hence, if first pregnancy results in normal healthy child, patient is mentally better prepared for subsequent pregnancies. Foetal head is said to be engaged when its biparietal diameter, the greatest diameter in an occiput presentation, passes through the pelvic inlet. Unengagement of head in primigravida has long been considered a possible sign of cephalopelvic disproportion.Methods: The study had 220 primigravida of which 110 had unengaged head as study group and 110 engaged head as controls. Data collection was done and the course of labour in all the patients recorded on partograph and all the patients were studied in detail. Engagement of the head was defined on the basis of Second Pawlik’s grip and Crichton’s fifth’s formula.Results: Our study shows that higher age group had more number of cases with unengaged head. The patient with engaged head had higher number of vaginal delivery than study group with unengaged head. More number of LSCS i.e. about 39.1% in study group as compared to 21% of controls is statistically significant difference (p value 0.05).Conclusions: We can conclude that primigravida with unengaged foetal head at onset of labour may deliver vaginally with minimal maternal morbidity, if proper monitoring and maintenance of partogram is done.
RESUMEN
Background: In Obstetrics it is traditional concept that fetal head engagement occurs by 38 weeks in primigravida. Unengaged head in primigravida has been considered a possible sign of cephalo pelvic disproportion. It is associated with higher risk of cervical dystocia, which has led to increased rate of caesarean section with its financial implication and future restriction of family size. Labour is prolonged, the duration of both latent and active phase increases, due to improper fitting high fetal head.Methods: The prospective descriptive study was conducted at the Yenepoya Medical College hospital OBG Department. Study population included were 75 primi gravidas with unengaged head at term. Details of labour were noted down. Augmentation was done with oxytocin and dose of oxytocin was titrated . CTG was used to monitor fetal heart. Emergency LSCS was performed in patients with fetal distress or non-progress of labour. In case of vagina delivery, duration of 1st and 2nd stage, APGAR score at 1 and 5 minutes, and birth weights were recorded.Results: Of the 75 primigravida 66.66% were in the age group of 21-25yrs. Majority of the women were of 39-40 weeks (42.66%) of gestation. Common causes of unengaged head was deflexed head in 15 (20%) CPD in 11 (14.66%), loops of cord around neck in 8 (10.66%), polyhydramnios in 2(2.66%), placenta previa type-I and II : anterior in 5 (6.66%) 8 patients were with occipito posterior position. No cause could be identified in 27 cases (36%). Vaginal delivery occurred in 68% and LSCS in 32%.Conclusions: Unengaged head in primi gravida with spontaneous onset of labour is not an indication for LSCS. The attitude of watchful expectancy and timely intervention especially in those cases in which no significant etiological factor is found, the chances of vaginal birth increase there by reducing maternal land foetal morbidity.