Abstract
Objective: The study was conducted to compare the outcome of labour between the unengaged and engaged head at the onset of labour at term in primigravidas. The aim was to determine the course of labour in between unengaged and engaged head in primigravida at term at the onset of labour and to study the maternal and neonatal outcome.
 Design: A prospective hospital-based comparative study.
 Methods: In this prospective comparative study, primigravida women at onset of labour at term who were admitted in labour room and satisfying inclusion and exclusion criteria were included. Group (I) study group included 110 primigravida at term with unengaged (at 37-41weeks) head at onset of labour and in Group (II) Control Group 110 primigravida at term with engaged (at 37-41weeks). Detailed clinical history, physical examination and investigation are reported. The duration of stages of labour and total duration of labour and its partographic analysis, need for Induction and augmentation of labour or surgical intervention, mode of delivery and fetomaternal outcome was recorded.
 Results: In Group I, 83.64% cases went into spontaneous labour while 90 % cases in Group II. 16.36% cases in group I and 10% cases in group II needed induction of labour with PGE2 gel. In group I, 68.18% required augmentation of labour compared to 33.63% in group II. Duration of 1st ,2nd stage of labour and total duration was more in group I as compare to group-II. Incidence of normal vaginal delivery and LSCS were 52.73%,32.73%respectivaly in group I while 71.82%,17.27% respectively in group II, the difference was statistically significant with p-value 0.011. Fetomaternal morbidity which was higher in group-I as compare to group-II was documented which was not statistically significant.
 Conclusion: The unengaged head in primigravida at the onset of labour at term can have normal vaginal delivery with appropriate induction and augmentation of labour and constant vigilance throughout the labour by partograph monitoring. Which can reduce primary caesarean delivery rate, maternal morbidity and healthcare expenditure in unengaged primigravida. Proper trial of labour in primigravida with unengaged head at term in the absence of cephalopelvic disproportion, vaginal delivery is possible with watchful expectancy with appropriate means of intervention.
 Keywords: Primigravida, Engaged, Unengaged, Lower segment caesarean section.
Highlights
Engagement is the initial cardinal movement of foetus in the mechanism of labour of a primigravida
Incidence of normal vaginal delivery and LSCS were 52.73%,32.73%respectivaly in group I while 71.82%,17.27% respectively in group II, the difference was statistically significant with p-value 0.011
Proper trial of labour in primigravida with unengaged head at term in the absence of cephalopelvic disproportion, vaginal delivery is possible with watchful expectancy with appropriate means of intervention
Summary
Engagement is the initial cardinal movement of foetus in the mechanism of labour of a primigravida. Many obstetricians take a pessimistic attitude toward eventual vaginal delivery if the head is not engaged by the onset of labour. One of the main reasons of this escalation is direct LSCS of primigravida with nonengaged fetal head at term, which is a frequently encountered finding in obstetric practice.[2] primigravida with unengaged fetal head at onset of labour may deliver vaginally if they are given fair trial of labor with watchful expectancy. There might be slight increase in the duration of labour but an unengaged fetal head in early labour should not by itself be an indication for early delivery by caesarean section.[3] The purpose of the present study was to analyse the progress of labor in primigravida with unengaged versus engaged fetal head, to determine the role of active medical and surgical interventions and to determine fetomaternal outcome. Group (I) Study Group included primigravida at term with unengaged (at 37-41weeks) head at onset of labour and 1|Page
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