Maternal outcome of primigravida patient with term pregnancy with engaged versus unengaged foetal head at onset of labour

ABSTRACT

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.