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NON ENGAGEMENT FETAL HEAD AT TERM, DEFINITION, During labour: - Coggle…
NON ENGAGEMENT FETAL HEAD AT TERM
Non-engagement of fetal head = when the fetal head has not entered the pelvic brim (not at 0 station) by term (≥37 weeks), especially in a primigravida (first pregnancy). Normally, the head should engage before labour in primigravida
CAUSES
Cephalopelvic disproportion (CPD) – head too big / pelvis too small.
Malposition / malpresentation – e.g. occipito-posterior, brow, face, or deflexed head.
High parity (multigravida) – head may only engage during labour.
Placenta praevia – placenta low lying blocking descent.
Pelvic abnormalities – contracted pelvis, fibroids, pelvic mass.
Fetal causes – hydrocephalus, macrosomia (big baby), abnormal lie (oblique/transverse).
MANAGEMENT
Assessment:
Careful abdominal & vaginal exam to confirm engagement.
Exclude CPD:
If suspected, refer to senior/obstetrician.
In primigravida:
If still not engaged at term, close monitoring is needed – may indicate CPD.
In multigravida:
Not always abnormal (head may engage in labour).
Observe progress carefully.
If no descent
→ consider trial of labour with close monitoring.
If obstructed / no progress
→ caesarean section.
Antenatal:
Ultrasound to check lie, presentation, placenta, fetal size.
COMPLICATIONS
Obstructed labour → maternal exhaustion, dehydration.
Uterine rupture (if mismanaged).
Fetal distress or death due to prolonged labour.
Increased operative delivery (C-section, instrumental delivery).
Postpartum complications: haemorrhage, infection, trauma.
DEFINITION
During labour: