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Clinical Study of Primigravida With Unengaged Head in Labour at Term

Labour begins with uterine contraction and ends with the delivery of newborns and expulsion of the placenta (1,2). According to (3), the left occipitoanterior position is more common than the right occipitoanterior as the left oblique diameter is encroached by the rectum. In addition, the engaging anteroposterior diameter of the head is suboccipitobregmatic (9.5 cm) and the transverse diameter is biparietal (9.5 cm). The descent is a continuous process, slow in the first stage but pronounced in the second stage provided that there is no undue bony or soft tissue obstruction. The progressive descent of the head is abdominally assessed by estimating the number of “fifths” of the head above the pelvic brim (Crichton). Further, 5/5th of the head is floating above the brim, 4/5th if the head is on the brim, and 3/5th if the head has a major part in the brim. Once the widest diameter has passed the brim, the head is assumed to be 2/5 palpable, and it is engaged or both poles of the fetal head (i.e., sinciput and occiput) are palpable by the 2nd pelvic grip. Internal examinations reveal the descent of the head to ischial spines and the position of the head (3). In primigravidas, engagement occurs in a significant number of cases before the onset of labour by around 38 weeks while in multiparas, the same procedure may occur in the late first stage with the rupture of the membrane. It is noteworthy that cephalopelvic disproportion should be ruled out in a primigravida with the nonengagement of the head even at labour (3). Furthermore, nulliparous women at term with a floating head are at the increased risk of cesarean section for abnormal labour. However, the majority of patients will still deliver vaginally (4). Moreover, primigravidas with an unengaged fetal head at term are considered as high-risk cases (5).