Abstract

ABSTRACT
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.