REVISITING FOETAL HEAD ENGAGEMENT, CLINICAL SCORES AND LABOUR OUTCOMES IN INDIAN RURAL PRIMIGRAVIDAE

Background: Childbirth, a complex physiological process, involves critical events such as foetal head engagement. This study focuses on the clinical assessment of foetal head engagement and its impact on labour outcomes in Indian rural primigravidae.Primigravidae,experiencing their first pregnancy,present unique challenges due to the significant changes in uterine and pelvic structures.The study aims to bridge the gap in existing knowledge by investigating the engagement status and its implications on labour outcomes in this demographic. Methods:The study was conducted at a tertiary care centre in Northern India, utilizing patient records from September 2023 to February 2024. The study included 140 primigravida patients from rural areas,with a gestation period of at least 37 weeks.Clinical examination of foetal head engagement was assessed using per abdominal and Bishop's scoring methods. Patients with obstetric complications or gestation beyond 40 weeks and peripartum complications were excluded. Results: Of the 140 patients,the mean age was 22.94 years and mean gestation period was 39 weeks.Foetal head engagement before labour was noted in 85 patients,during labour in 23,and unengaged in 32.Engagement status significantly influenced the mode of delivery, with unengaged heads more likely to result in caesarean sections. Lower Bishop's score and higher perabdomen scores were found to be statistically significant predictors of adverse labour outcomes.Younger patients were also more prone to caesarean sections. Statistically significant differences were observed in mean baby weight and gestation period between vaginal deliveries and caesarean sections. Conclusion:Foetal head engagement is a crucial predictor of labour outcomes, with unengaged heads at labour onset being more likely to necessitate caesarean sections. Clinical scores like Bishop's and per abdominal scores are valuable tools for predicting delivery mode, especially in resource-limited rural settings.Early and accurate assessments can improve labour outcomes by enabling timely interventions and referrals. Addressing the disparities in maternal healthcare between rural and urban areas through education and clinical practices is essential for better pregnancy outcomes.