title: Clinical significance of the floating fetal head in nulliparous women in labor.
abstract: OBJECTIVE
  To examine the course of labor in nulliparous women in active labor with a floating fetal head.
  
  
  METHODS
  A prospective, cohort study of nulliparous women presenting in active labor at term with a floating fetal head (station > or = -3, n = 108) or engaged fetal head (n = 241). All patients were examined by a senior physician. Assignment to the study or control group was noted in the investigator's records. However, management of labor was at the discretion of the labor ward team on duty.
  
  
  RESULTS
  Cesarean section rates for failure to progress were significantly higher in the study group (17.1% versus 4.2%, P < .0001), and the second stage of labor was prolonged (65.3 +/- 27.1 versus 54.9 +/- 30.2 minutes, P < .03). None of the women who had a persistently floating fetal head at 7 cm of cervical dilation delivered vaginally. Birth weights were larger (P < .03) and Apgar scores lower (P < .0001) in the study group. The lengths of the active phase and instrumental delivery rates were similar in the two groups.
  
  
  CONCLUSIONS
  Nulliparous women presenting in active labor at term with a floating head are at substantially increased risk of cesarean section for abnormal progress of labor. However, the majority of patients will still deliver vaginally. A persistently floating head with advanced cervical dilation (7 cm) should prompt consideration of cesarean section since little is to be gained by waiting.
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Debby
authors.forename: Sigi
authors.initials: S
authors.lastname: Rotmensch
authors.forename: Ofer
authors.initials: O
authors.lastname: Girtler
authors.forename: Oscar
authors.initials: O
authors.lastname: Sadan
authors.forename: Abraham
authors.initials: A
authors.lastname: Golan
authors.forename: Marek
authors.initials: M
authors.lastname: Glezerman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007745:Labor Onset; D007746:Labor Presentation; D007747:Labor Stage, First; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000517:prevention & control*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment