Materials and Methods: A hospital-based prospective study was conducted between August 2017 and September 2019 at hospitals affiliated with Kasturba Medical College, Mangalore. All primigravidas with an unengaged head at term with single live intrauterine gestation and vertex presentation with no cephalo pelvic disproportion were included in the study. The time of engagement, engagement to delivery interval, duration of labour, and oxytocin augmentation with the number of “fifths” of the fetal head above the pelvic brim were analyzed based on the aim of the study.

Results: A total of 350 women were evaluated in this study. The free-floating fetal head, 4/5th palpable fetal head, and 3/5th palpable were observed in 251 (71.7%), 65 (18.6%), and 34 (9.7%) subjects, respectively. In addition, 270 (77.14%) women were in the gestational period of 38-40 weeks and 191 (76.1%) of them had the fetal head level above the brim at 38-40 weeks of gestation. Among the free-floating head, 205 (68.1%) and 62 (95.4%) cases in the 4/5th level of fetal head engaged in the active phase of labour and were found to be statistically significant (P = 0.0001). Further, the duration of labour was more than 6 hours in 159 (67.1%) in the free-floating head and 39 (60%) in the 4/5th level of the fetal head (P = 0.000). Finally, 109 (43.4%) of women with the free-floating head delivered by cesarean section (P = 0.087).

Conclusions: In general, primigravida with an unengaged fetal head at term in labour requires intense monitoring, intervention, and labour augmentation in order to reduce the maternal morbidity and perinatal complications.