Chaudhary Saima, Farrukh Rubina, Dar Asma, Humayun Shamsa
Department of Obstetrics and Gynaecology, Fatima Jinnah Medical College, Lahore, Pakistan.
J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):131-4.
Primigravidas with unengaged foetal head at term should be regarded as high risk cases. It is seen that nuglliparous women with the floating foetal head demonstrate higher rates of caesarean section than those with dipping or engaged head in early labour. These cases should be regarded as high risk and identified early and should be referred to a tertiary care centre where good facilities for operative delivery are available. The present study was undertaken to determine the outcome of labour in nulliparous women with unengaged head and compare it with those who present with engaged head at term as a case control study. The objective of the study was to enumerate the outcome of labour in nulliparous women presenting with unengaged head at term and compare it with those who present with engaged head in early active labour.
It was a case control study, completed in 11 months, conducted in Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore. 300 women were selected by convenience sampling. 150 nulliparous women who presented with unengaged head in early active labour were taken as cases, out which 2 women left against medical advice with their medical records so data was missing leaving 148 patients in this group. While 150 nulliparous women who presented with engaged head were taken as controls.
C-section rates was significantly found to be more in unengaged group being 16.89%, compared with 5.33% in engaged group (p = 0.000). Most of C-sections were carried out due to failed progress of labour (48%). Patients with unengaged foetal head had significantly lower APGAR scores at 1 (p < 0.002) and 5 min (0.003) and higher mean birth weights (p = 0.002).Cases also had significantly longer 1st (p = 0.0001) and 2nd stage (p = 0.004) of labour.
Engaged vertex at the onset of active labour is associated with a lower risk of caesarean delivery in nulliparous women. Patients with unengaged vertex are at higher risk for caesarean delivery due to arrest disorders. In addition to the higher caesarean rate patients with unengaged vertex are at risk of having lower foetal APGAR scores and higher mean birth weights of newborns.
足月时胎头未衔接的初产妇应被视为高危病例。可以看到，胎头浮动的未产妇剖宫产率高于产程早期胎头入盆或衔接的未产妇。这些病例应被视为高危病例并尽早识别，应转诊至具备良好手术分娩设施的三级医疗中心。本研究旨在确定胎头未衔接的未产妇的分娩结局，并将其与足月时胎头衔接的未产妇进行病例对照研究。该研究的目的是列举足月时胎头未衔接的未产妇的分娩结局，并将其与产程早期活跃期胎头衔接的未产妇进行比较。
这是一项病例对照研究，在拉合尔甘加拉姆爵士医院妇产科进行，历时11个月。通过方便抽样选取300名女性。将150名产程早期活跃期胎头未衔接的未产妇作为病例组，其中2名女性不听从医嘱并带走病历，导致数据缺失，该组剩余148名患者。而将150名胎头衔接的未产妇作为对照组。
显著发现未衔接组的剖宫产率更高，为16.89%，而衔接组为5.33%（p = 0.000）。大多数剖宫产是由于产程进展失败（48%）。胎头未衔接的患者在出生后1分钟（p < 0.002）和5分钟（0.003）时的阿氏评分显著更低，平均出生体重更高（p = 0.002）。病例组第一产程（p = 0.0001）和第二产程（p = 0.004）也显著更长。
活跃期开始时胎头衔接与未产妇剖宫产风险较低相关。胎头未衔接的患者因产程停滞障碍剖宫产风险更高。除了剖宫产率较高外，胎头未衔接的患者有新生儿阿氏评分较低和平均出生体重较高的风险。
