Unengaged vertex in nulliparous women in active labor: A risk factor for cesarean delivery

Samuel Falzone, Suneet P. Chauhan, Julie A. Mobley, Teresa G. Berg, Donald M. Sherline, Lawrence D. Devoe

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


OBJECTIVE: To compare the route of delivery among nulliparous parturients with and without an engaged vertex in the early, active phase of labor. METHODS: Prospectively, the position of the fetal head was ascertained among nulliparous women at 37 weeks' gestation or more in early, active labor (cervical dilation ≤4 cm with adequate contractions). Sixteen variables, including maternal demographics, obstetric complications and intrapartum course, were examined using X 2 and logistic regression analysis. RESULTS: Among the 77 patients, 33 (42.8%) had an unengaged vertex and 44 (57.2%) had an engaged vertex in active labor. Of the 22 cesarean deliveries for arrest disorder, 2 were in the engaged and 20 in the unengaged group (P <.001). The mean birth weight was similar among those who had vaginal (3,211 ± 416 g) and cesarean delivery (3,400±489 g, P= .08). Univariate analysis indicated that chorioamnionitis (relative risk [RR] 2.6, 95% confidence interval [CI] 1.4-4.9) and unengaged vertex (RR 13.3, CI 3.3-53.0) were associated with cesarean delivery for arrest disorders. When entered into a multiple logistic model, only unengagement in the early active was a risk factor for cesarean delivery. The following were not associated with cesarean delivery: maternal demographics, gestational age, estimate of fetal weight, presence or absence of meconium, preeclampsia, diabetes mellitus, private obstetric care or use of epidural anesthesia. CONCLUSION: Among nulliparous parturients, an unengaged vertex is a significant risk factor for cesarean delivery for arrest disorders.

Original languageEnglish (US)
Pages (from-to)676-680
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Issue number8
StatePublished - Aug 1998


  • Cesarean section
  • Labor
  • Nulliparity
  • Unengaged vertex

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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