• The Medical Journal of Basrah University

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    • Abstract: Ali F. Al-Assadi, FICOG, CABOG, Department of Obstetrics and Gynaecology, College of Medicine, University of Basrah, Iraq. ... Essentials of obstetrics & gynecology. 3. rd. edition.. Philadelphia. W.B.Saunders Co. 1998; ...

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The Medical Journal of Basrah University
Ali F. Al-Assadi
Objective: To compare the route of delivery among nulliparous women with & without an engaged vertex in the
early, active phase of labor & to evaluate the significance of unengaged vertex in early active labor as a risk
factor for cesarean delivery. Setting: labor room in Basra maternity hospital. Design: This is a prospective
case- control study; the station of the fetal head was assessed among 80 nulliparous women at ≥37 weeks
gestation in early, active labor (cervical dilatation ≥4 cm. with adequate uterine contractions). Variables were
analyzed using Z-test. Results: among the 80 nulliparous, 36 had an engaged vertex & 44 had an unengaged
vertex. The cesarean section rate for arrest disorders was significantly higher in the unengaged group (38.6%)
than that in the engaged group (8.33%). 61.4% of nulliparous women with unengaged vertex had vaginal
delivery. The sensitivity & specificity of unengaged vertex in nulliparous women in active labor as a test to
predict cesarean section delivery were (38.6%) & (91.7%) respectively. Conclusion: among nulliparous
parturients, an unengaged vertex is a significant risk factor for cesarean delivery but those parturients should
have a trial of labor because about (61.4%) of them were succeeded in achieving vaginal delivery.
he term station is used to describe the pregnancies with no known anomalies. Pregnant
level of the foetal presenting part within women were excluded for malpresentation or if
the birth canal in relation to the ischial a caesarean section was performed for any
spines. The foetal head is engaged when the indication other than arrest disorders. The
leading edge of the head is at the level of the following variables were recorded: maternal
ischial spines[1] i.e. the foetal station is zero.[2-4] demographics, preeclampsia, diabetes mellitus,
Conversely, the foetus is unengaged when the and use of oxytocin, foetal station in early
leading foetal part is above the level of the active phase, meconium-stained liquor, and
ischial spines.[2-4] Engagement has occurred in chorioamnionitis. All women had estimation of
the vast majority of nulliparous women prior to neonatal birth weight at time of delivery. The
labour, but not in the majority of multiparous foetal station was determined in early labour.
women.[5-6] Friedman & Sachtleen[2] Active phase of labour was defined as cervical
demonstrated that higher stations at the onset of dilatation ≥4 with ≥3 contractions / 10 min.s.
labour were associated with an increase in the All parturient had intermittent foetal heart &
duration of labour & in the incidence of uterine activity monitoring. Unengagement was
dysfunctional labour patterns. Therefore, an defined as a foetal station

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