Influence of the level of symphsis pubis on the time of fetal head engagement in primegravidae mothers at Mulago Hospital.

Abstract

Introduction Fetal head engagement is used to demonstrate the maternal pelvic capacity to accommodate the fetal head. In the African mother the high prevalence of mothers with small pelvic dimensions makes this assessment especially important. African mothers have an observed delay in fetal head engagement. The difference in pelvis orientation could also explain the various postures used to ease the process of delivery. Objective To determine the association between maternal pelvic orientation and time of fetal head engagement in prime gravidae mothers at Mulago Hospital Methodology This cohort study was carried out in the Mulago Hospital assessment center antenatal clinics. There were 278 mothers who were recruited. Each mother had a measurement done to determine the level of her symphysis pubis in addition to the routine antenatal clinical examination. Results There were more mothers with un-engaged fetal heads than engaged in this study (87% vs. 12.9%, P<0.001). More mothers had a low symphysis pubis versus those with a high symphysis pubis (67% vs. 33%, P<0.001). Change in maternal posture led to a 63.2% increase in the accuracy of determining fetal head engagement in mothers with a low symphysis pubis. There was a significant increase in fetal head engagement at the 38m week of gestation [OR 0.39 (0.1 5-0.98)]. Conclusion Orientation of the maternal pelvis does influence the fetal head engagement in the African primegravidae mother.