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Indian Journal of Obstetrics and Gynecology Research


The outcome of labour in primigravida with term gestation and unengaged head at onset of labour


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Author Details: Sunita Sudhir, Sunita Mishra

Volume : 3

Issue : 3

Online ISSN : 2394-2754

Print ISSN : 2394-2746

Article First Page : 199

Article End Page : 202


Abstract

Introduction: Primigravida are the group at risk. As Ian Donald has said that “Primigravida is a dark and untrained horse and potential for child bearing is determined by the outcome of labour”.
Labour is onset of regular uterine contraction followed by progressive cervical dilatation, effacement and descent of presenting part. Engagement is the first step in the mechanism of labour of a primigravida. Those with unengaged head at onset of labour are considered to be at high risk for operative delivery.
Objective: To study the course of labour, need for intervention and fetal outcome in primigravida with unengaged fetal head at term gestation at onset of labour.
Methods: A prospective study carried at Dept. of OBG at Rural medical college of Telangana state from July15 to Dec15. Total 120 primigravidas with unengaged head at term and at onset of labour were studied. Detailed history was taken in each case. General, systemic and obstetric examination was done. Ultra sonography was done in all cases and risk factors were ruled out. Cardio tocography (CTG) was done to know the fetal condition, partogram was used to monitor the progress of labour and interventions like augmentation and instrumental delivery.
Results: Out of the 120 women, 91 women were in the range of 20-30 yrs, and 29 women were of less than 19 yrs. The mean duration of labour, 1st stage –(7hrs min 30 min to 10hrs 45 min) and 2nd stage (55 min to 110 min) out of total 120 cases 78 cases had vaginal delivery and 42 cases needed caesarean section. Among the 78 cases who delivered vaginally 14 cases had forceps delivery, 6 cases had vaccum assisted delivery and rest of the 58 cases had normal vaginal delivery. 42 cases required emergency LSCS, the commonest indication being failure of progress of labour. APGAR score was recorded at 5 min, 81 cases had APGAR score in the range of (7-10), in 33 babies APGAR score was (4-6), <3 APGAR score seen in 6 babies.  10 babies required NICU admission.
Conclusion: Primigravida at term gestation with unengaged head at onset of labour should not be the sole indication for LSCS. Vaginal delivery is possible with watchful expectancy and usage of appropriate means of intervention.

Keywords:
Primigravida, Unengaged head, Vaginal delivery, Caesarean section