The unengagement of the fetal head in primigravida has long been considered a possible sign of cephalopelvic disproportion. Unengagement at the onset of labour is a predictor of an increased chance of caesarean section. This prospective study was carried out to observe the progress of labour, necessity of medical and surgical induction and fetal outcome in primigravida women with an unengaged versus engaged fetal head among the patients admitted to the labour room at the department of Obstetrics and Gynaecology of Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet from January 2018 to December 2018. A total of 140 patients were enrolled in this study, divided into groups A and B. Seventy primigravida with an unengaged fetal head were considered as group A and 70 with an engaged fetal head at the onset of labour were considered as group B. The majority of unengaged patients 18 (25.7%) were found in deflexed heads, followed by 13 (18.6%) in cephalo-pelvic disproportion, 4 (5.7%) in loops of cord around the neck, 2 (2.9%) in prelabour rupture of membranes and 31 (44.3%) in no cause of unengagement. Almost half (48.6%) of patients had spontaneous vaginal delivery in the unengaged and 50 (71.4%) in the engaged group. Twenty nine (41.4%) patients were found in spontaneous labour in the unengaged group and 53 (75.7%) in the engaged group. Post partum haemorrhage (PPH), perineal tears, cervical tears, wound infection, fetal distress, puerperal sepsis, and hospital stay were not statistically significant (p>0.05) between the two groups. The primigravida with an unengaged head at term should be regarded with suspicion and the same woman in labour should be regarded with apprehension.

Keywords: Primigravida with unengaged head, High head at term, Unengaged head in labour.