الفهرس 
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Abstract
SUMMARY
It had been a traditional concept that engagement of the fetal head in primigravidas occurs at 38 weeks of gestations. This was found to be rather away from what is seen in practice. A large number of primigravidas presented at full term with unengaged fetal head. Large number of them presented in active labor.
Engagement has been defined as the passage of the large transverse diameter of the fetal head (biparietal diameter) through the pelvic inlet. Clinically it has been defined when the fetal head has been felt at the level of the ischial spines and is referred to as station zero. Any station above this level has been given lower number -1,-2,-3,-4 and -5.
The aim of our study is to see the effect of unengaged head in primigravidia in onset and success of normal vaginal delivery
This study was conducted on 200 primigravidas with group A (unengaged fetal) and group b ( 100 cases with engaged fetal head ) presented at term in active labor. Any solid indication for cesarean section whether in the mother or the fetus was excluded. These cases were given a full trial of labor and the progress of each was recorded on a partogram. The mode of delivery, the duration of labor (first and second stage), the weight of the new born and the Apgar score were all recorded. Also maternal morbidity and mortality were recorded.
After collecting the results from our data sheet and analyzing them we found that most of the patients included in the study delivered vaginally (70%) and 30 % only delivered by CS. The causes for CS in group A was 20% due to arrest of progress , 6% due to fetal distress and 2% due to obstructed labour. The rate of CS in fee floating heads of group A was 85.7% p value is 0.001which is significant for CS while 16.36% (9) of women in -3 station delivered by CS and maximum number of cases with station -1 and -2 delivered by normal vaginal delivery . The primigravida with unengaged fetal head at onset of labor, although at risk for C.S. most of them would deliver vaginally if they were given a full trial of labor and watched carefully. The length of the first and second stage of labor was prolonged than cases with engaged head with significant p value . The need for oxytocin augmentation is also increased in these patients. The Apgar score at 5 minutes are good. There were large number of maternal morbidity among the primigravidas presented with unengaged fetal head but without significant difference between two groups .