Outcome of Labor in Nullipara at term with Unengaged vertex

Document Type : Original Article

Authors

1 Clinical instructor in Obstetrics and Gynecological Nursing- Faculty of Nursing- Zagazig University

2 Professor of Obstetrics and Gynecological nursing- Faculty of Nursing- Zagazig University

3 Assist. Prof. of Obstetrics and Gynecological nursing- Faculty of Nursing- Zagazig University

4 Lecturer of Obstetrics and Gynecological nursing- Faculty of Nursing- Zagazig University

10.12816/0029159

Abstract

Background: Unengagement of the head in primigravida has long been considered a possible
sign of cephalopelvic disproportion. It is associated with a higher risk of obstructed labor.
The aim of this study was to; assess outcome of labor in nullipara at term with unengaged
vertex. Setting this study was conducted in labor and premature Hospital at Zagazig
Maternity Hospitals. Subjects: a representative sample of 200 parturient women (100 had
engaged head and 100 had unengaged fetal head) was recruited for this study. The tools used
for data collection were; an interview questionnaire sheet, a clinical assessment form, the
partograph, a summary of labor sheet and a neonatal assessment sheet. The results of the
present study revealed that in more than three fifth (63.0%) of women with unengaged head
the cause was unknown but it was most common among those with deflexed head (25.0%),
they also had significantly longer first stage of labor (p=0.000). Cesarean section rate was
significantly found to be more in the unengaged group being 35.0%. Most of the C-sections
were carried out due to failed labor progress (76.9%). Patients with unengaged fetal head had
significantly lower Apgar scores in 1st (p=0.000) and 5th min (p= 0.446). Conclusion: It can
be concluded that, patients with unengaged vertex are at higher risk for cesarean delivery due
to arrest disorders as well as lower fetal APGAR scores. Recommendations: The study
recommended that, the watchful expectancy and timely intervention, especially in cases
where no etiological factor is found, by blotting a partogram and using oxytocin judiciously
when labor appears to be taking a protracted course, most of the women with unengaged head
will deliver vaginally with minimal maternal and fetal morbidity.

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