Fetal Outcome and Vaginal Delivery Rates Among Primigravidae With Unengaged Head at Onset of Labor

Abstract

Background:The criteria for diagnosing delivery disorders in the first and second stages of labor remain controversial. It is generally accepted that an elevated position of the fetus in primigravidas during short-term labor may indicate a threat to normal progression of labor due to fetal-pelvic disproportion or obstruction of the fetal passage by tumor or placenta.Objective: To determine fetal outcome and vaginal delivery rates among primigravida with unengaged head at onset of labor.Patients and Methods: This study was conducted on 250 primigravidae with unengaged fetal head presented at term in active labor during the period from January 2019 to December 2019. Any solid indication for cesarean section whether in the mother or the fetus was excluded.These cases were given a full trial of labor and the progress of each was recorded on a partogram, The mode of delivery, the duration of labor (first and second stage), the weight of the new born and the Apgar score, were all recorded.Also maternal morbidity and mortality were recorded. Epidural anesthesia was given to the patients on demand, and the effect of it on the mode of delivery, the duration of the first and second stage and the Apgar score were reported.Results: Most of the patients included in the study delivered vaginally (82%) while only 18% delivered by cesarean section. The primigravida with unengaged fetal head at onset of labor, although at risk for C.S, most of them delivered vaginally when were given a full trial of labor and watched carefully. The length of the first and second stage of labor prolonged slightly in these patients. The need for oxytocin augmentation also increased in those patients.The Apgar score at 1 minute and 5 minutes also decreased in the new-born of these primigravidae. There were no differences in maternal morbidity among the primigravidas presented with unengaged fetal head and those presented with engaged fetal heads. The use of epidural anesthesia did not affect the rate of C.S. although it may lengthen the duration of the first and second stage of labor. In addition, Apgar score was not affected by the use of epidural. Conclusion:The primigravida with unengaged fetal head at onset of labor, although at risk for C.S., most of them delivered vaginally with a full trial of labor and watching carefully.

Comparison Of Outcome In Engaged Versus Unengaged Fetal Heads In Primigravida

“…10 The results of our study showed mean birth weight of 3.01kg. El-Desouky ESAS et al 11 in their study of engaged versus unengaged fetal heads in primigravida women reported a mean birth weight of 3kg which is consistent with the findings of our study. Ashwal E et al in their study described a birth weight of 3.2 kg.…”