Comparative study between unengaged and engaged fetal head in primigravida at term or in labour

Background: The aim of the study is to compare and evaluate between unengaged (UE) and engaged (E) groups at term or in labour, incidence of unengaged and engaged heads, need for medical or surgical intervention, progress of labour and feto-maternal outcome.Methods: It is a prospective comparative study carried at tertiary care hospital for a period of 18mths from May16-November17. Out of 377 patients, 100 patients were selected in each group with unengaged (group A) and engaged (group B) heads. Patients consent, and ethical approval was taken. History, examination and investigation was done at each visit. Incidence of unengaged heads at term or in labour, duration of each phase of labour and its partographic analysis, need for medical or surgical intervention, mode of delivery and fetomaternal outcome was calculated.Results: Incidence of unengaged heads at term is 61%. 17% patients in unengaged group as compared to 10% required induction of labour while 73(73%) patients in unengaged group required augmentation with oxytocin as compared to 36(36%) patients in engaged group. Duration of labour in each phase was more in unengaged group. Incidence of lower segment caesarean section (LSCS) was 37% in unengaged group as compared to 23% in engaged group. Fetomaternal morbidity which was higher in unengaged was documented.Conclusions: Although with unengaged head being a significant risk factor for LSCS, with watchful expectancy and careful intervention, most patients will deliver vaginally with minimal fetomaternal morbidity