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

Goyal, Aditi; Wadhwani, Rekha

doi:10.18203/2320-1770.ijrcog20193106

Cited by 5 publications

(9 citation statements)

References 2 publications

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“…Adita et al reported a comparative study of 110 women with unengaged head (group A) and 110 women with engaged head (group B). 4 There were 15 cases in group A and 9 cases in group B with age more than 30 years. In the present study there was only 1 case each in both groups.…”

Section: Discussionmentioning

confidence: 91%

“…According to Aditi et al and Mahendra et al non progress of labour was common indication in group A. 1,4,6 According to Siama et al total duration of labour in 34% of group A and 74% of group B was<12 hours. 6 Remaining 66% in group A and 26% in group B took>12 hours.…”

Section: Discussionmentioning

confidence: 97%

“…Hence if the first pregnancy results in normal healthy child, patient is better prepared for subsequent pregnancies. 4 Primigravida and nulliparae are obstetric high risk group especially, the very young and the elderly, where pregnancy and labour must be supervised. 5 Fetal head is said to be engaged when it's biparietal diameter, the greatest transverse diameter in occiput presentation, passes through pelvic inlet.…”

Section: Introductionmentioning

confidence: 99%

“…Unengagement of fetal head in primigravida has long been considered as cephalo-pelvic disproportion. 4,6 The traditional concept that engagement of head occurs by 38 weeks in primigravida, is not validated in clinical practice. In majority of primigravida, the engagement occurs between 38-42 weeks or even during the first stage of labour.…”

Section: Introductionmentioning

confidence: 99%

“…In majority of primigravida, the engagement occurs between 38-42 weeks or even during the first stage of labour. 4,5,[7][8][9] Unengagement of head in primigravida is associated with high risk of obstructed labour. Non engagement of head at the onset of active labour is a predictor of the risk of caesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Obstetric outcome in primigravida with unengaged versus engaged fetal head at term

Sirisha¹,

Chiniwar²,

Menasinkai

2020

Int J Reprod Contracept Obstet Gynecol

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Background: Labour although a physiological process can present challenges to clinician and patient. Primigravida and nulliparae are obstetric high-risk group, especially the very young and the elderly, where pregnancy and labour must be supervised. The study was done to compare the maternal and fetal outcome in primigravida with unengaged and engaged head at term.Methods: A prospective study was done for a period of 18 months from June 2018 to December 2019 in Department of Obstetrics and Gynaecology Adichunchanagiri Institute of Medical Sciences and Research Center. 100 women with unengaged head at term (group A) and 100 women with engaged head at term (group B) as controls were selected. All the relevant data was filled in the partogram. Following observations were made, station of fetal head at the onset of labour, course of labour, duration of labour, any medical or surgical interventions or caesarean delivery. Data was analysed by SPSS 20.0 software and p value<0.05 was taken as statistically significant.Results: in group A 49% and 63% in group B had vaginal delivery. 17% of group A and 14% of group B had instrumental vaginal delivery. Caesarean delivery was 34% in group A and 23% in group B. The mean total duration of labour was 13.53 hours in group A and 9.73 hours in group B. P value was 0.000.Conclusions: Duration of labour was more in group A than group B. Proper supervision and timely intervention in cases with an unengaged head can have vaginal delivery.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Obstetric outcome in primigravida with unengaged versus engaged fetal head at term

Sirisha¹,

Chiniwar²,

Menasinkai

2020

Int J Reprod Contracept Obstet Gynecol

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Predicting the Mode of Delivery by Angle of Progression (AOP) before the Onset of Labor by Transperineal Ultrasound in Nulliparous Women

Minajagi

Srinivas

Hebbar

2020

CWHR

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Background: Prediction of the mode of delivery is crucial for better labour outcome. Recent studies suggest that the angle of progression (AOP), measured using transperineal ultrasound, can substantially aid the assessment of fetal head descent during labor, thereby predicting the mode of delivery. Objective: To assess the ability of the AOP measured by transperineal ultrasound to predict the mode of delivery in nulliparous women before the onset of labor. Methods: A prospective observational study was conducted at our hospital, of nulliparous women who had presented to the antenatal clinic at ≥ 38 weeks of gestation but not in labor. AOP was measured using transperineal ultrasonography and compared among the women having Caesarean section (CS) due to labor dystocia and vaginal delivery (VD). Various other confounding factors which increase the risk of caesarean section were analyzed. Results: Among total 120 nulliparous women, the mean AOP was narrower in patients undergoing CS (n = 28) compared to those with VD (n = 92) (91.6 ± 6.1° vs. 100.7 ± 6.9°; P < 0.01). Multivariable logistic regression analysis revealed that narrow AOP values (OR 3.66; P < 0.001; 95% CI 1.7- 14.5) and occiput-posterior fetal position (OR 1.63; P = 0.04; 95% CI 1.0-7.5) were the independent risk factors for CS. An AOP ≥ 96° (calculated from the ROC curve) was associated with VD in 95% (76/80) of women and an AOP < 96° was observed among 60% (24/40) of women who underwent CS. Conclusion: Narrow AOP (< 96°) and occiput-posterior fetal position are at higher risk for CS due to labor dystocia. AOP measured at the antenatal period could accurately predict the mode of delivery, thereby modifying labor outcome.

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A COMPARATIVE STUDY OF PRIMIGRAVIDA WITH UNENGAGED V/S ENENGAGED HEAD AT ONSET OF LABOUR AT TERM IN THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

Loyal

Banerjee

2022

IJMBS

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Objective: The study was conducted to compare the outcome of labour between the unengaged and engaged head at the onset of labour at term in primigravidas. The aim was to determine the course of labour in between unengaged and engaged head in primigravida at term at the onset of labour and to study the maternal and neonatal outcome. Design: A prospective hospital-based comparative study. Methods: In this prospective comparative study, primigravida women at onset of labour at term who were admitted in labour room and satisfying inclusion and exclusion criteria were included. Group (I) study group included 110 primigravida at term with unengaged (at 37-41weeks) head at onset of labour and in Group (II) Control Group 110 primigravida at term with engaged (at 37-41weeks). Detailed clinical history, physical examination and investigation are reported. The duration of stages of labour and total duration of labour and its partographic analysis, need for Induction and augmentation of labour or surgical intervention, mode of delivery and fetomaternal outcome was recorded. Results: In Group I, 83.64% cases went into spontaneous labour while 90 % cases in Group II. 16.36% cases in group I and 10% cases in group II needed induction of labour with PGE2 gel. In group I, 68.18% required augmentation of labour compared to 33.63% in group II. Duration of 1st ,2nd stage of labour and total duration was more in group I as compare to group-II. Incidence of normal vaginal delivery and LSCS were 52.73%,32.73%respectivaly in group I while 71.82%,17.27% respectively in group II, the difference was statistically significant with p-value 0.011. Fetomaternal morbidity which was higher in group-I as compare to group-II was documented which was not statistically significant. Conclusion: The unengaged head in primigravida at the onset of labour at term can have normal vaginal delivery with appropriate induction and augmentation of labour and constant vigilance throughout the labour by partograph monitoring. Which can reduce primary caesarean delivery rate, maternal morbidity and healthcare expenditure in unengaged primigravida. Proper trial of labour in primigravida with unengaged head at term in the absence of cephalopelvic disproportion, vaginal delivery is possible with watchful expectancy with appropriate means of intervention. Keywords: Primigravida, Engaged, Unengaged, Lower segment caesarean section.

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

Cited by 5 publications

References 2 publications

Obstetric outcome in primigravida with unengaged versus engaged fetal head at term

Obstetric outcome in primigravida with unengaged versus engaged fetal head at term

Predicting the Mode of Delivery by Angle of Progression (AOP) before the Onset of Labor by Transperineal Ultrasound in Nulliparous Women

A COMPARATIVE STUDY OF PRIMIGRAVIDA WITH UNENGAGED V/S ENENGAGED HEAD AT ONSET OF LABOUR AT TERM IN THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

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