Nadia Khurshid, Farhan Sadiq.
Management of primigravida with unengaged head at term.
Pak J Med Health Sci Jan ;6(1):36-8.

Objective: To an increase in overall caesarean section rate. The incidence of active medical and surgical intervention in cases of primigravidas with high head at onset of labour is quite high. Design: Case Series. Place and duration of study: This prospective study was carried out in Gynae unit 3, Lady Willingdon Hospital Lahore from March 1997 to Oct 1997. Patients and methods: In this series of study, 100 primigravidas with unengaged head at term and at the onset of labour were recruited. All cases were studied in detail with reference to course of labour, mode of delivery, interference required and maternal and fetal outcome. A detailed history was taken and general and systemic examination was done. Adequacy of pelvis and diagnol conjugate was accurately measured. Intrapartum ultrasonography was done. Results: The incidence of high head in primigravidas at term was 22 %.The most common aetiology was deflexed head and next commonest was cephalopelvic disproportion.In 40% no cause found. Vaginal delivery occurred in 67% of cases, 33% of cases had caesarean section. No interference i.e., ventouse or forceps required in 60% of cases. In 64% cases labour lasted more than 12 hrs. Conclusion: With judicious use of oxytocin and careful monitoring of progress of the labour on partograms, this is possible to deliver most of these primigravidas with high heads vaginally with minimal maternal and fetal morbidity and C- sections can be avoided in many if not all of these cases.

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