Unengaged head in primigravidae, mode of delivery and outcome (a case-control study) in Dongola—Sudan (2019)

Abstract

Background: Child birth is difficult period and associated with strenuous stress for the birth attendants as well, the parturient ladies, especially in primigravidae whose pelvis has not been tested. Methods: A prospective case-control study at Dongola maternity hospital. To assess mode of delivery and outcome in primigravidae with unengaged head. The study included 248 primigravidae at term, singleton, and in labor, divided into case and control groups equally, unengaged and engaged head. Results: The overall results among both case and control group revealed no difference in mode of delivery, vaginal delivery was (77.4%) and (83.9%), respectively. The significant findings were: head position as it was in the case group 24.2% O.A, 58.1% O.T, and 17.7% O.P. The corresponding figures in control group were 29%, 64.5%, and 6.5%. The difference was significant ( P = 0.024). 91.9% of the case group augmented and 77.4% in the control group ( P = 0.002). The most interesting significant difference was body mass index. in the control group 3.2% had a BMI of <20 kg/m 2 , 50% had a BMI 20–25 kg/m 2 , 16.8% had a BMI 25–30 kg/m 2 , and 30% had a BMI >30 kg/m 2 . In the cases, group were 3.7%, 31%, 25.3%, and 40% sequentially with significant difference ( P = 0.011). Conclusion: With good conduction of labor, there were no difference in mode of delivery and outcome in primigravidae with unengaged fetal heads.

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

“…Caesarean section is most commonly sought surgery in a primigravidae with unengaged head. 7 Studies report a higher risk for caesarean section among nulliparous women with a floating head when the progress of labour is perceived to be abnormal. 8 However our study shows that this does not have to be the case with continuous monitoring.…”