Unengaged Head in Primigravidas, Will it Affect the Chance of Having a Vaginal Birth?

Objective: To evaluate if the presence of unengaged head in primigravidas reduces the chance of having a vaginal birth. Background: Prospective observational study. This study was carried out in Obstetrics and Gynecology emergency Department, Cairo University Teaching Hospital, Cairo, Egypt. Patients and Methods: 150 primigravidas with unengaged head at term and at the onset of labour were recruited. The course of labour and any intervention were documented. Intrapartum ultrasonography was performed. Intrapartum and postpartum events were recorded. Results: Vaginal delivery was achieved in 119 patients (79.3%) whereas 31 patients had cesarean section (20.7%). Forceps delivery and Ventouse deliveries were required for delivery of 2 patients (1.3%). The most common indication of cesarean section was arrest of progress in 21 patients (67.7%) followed by pathological fetal heart rate tracing in 6 patients (19.3%) and followed by obstructed Labour in 4 patients (12.9%). Duration of the first stage ranged from 1.5 hour to 14.5 hours (mean 5.98 hour). Duration of the second stage ranged from 30 minutes to 150 minutes with a mean of 46.69 minutes. Maternal as well as fetal morbidity were documented. Conclusion: Primigravidas with high head can have a vaginal birth with prober use of oxytocin, epidural analgesia and fetal heart rate monitoring.