Background: Labour in nulliparous women is a crucial obstetric process, and foetal head engagement is a key determinant of labour progress and clinical decision-making. The purpose of the study is to determine the incidence of foetal head engagement and non-engagement at ≥38 weeks in nulliparous women and evaluate their maternal and fetal outcomes. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from January to December 2009, and included 100 nulliparous women at ≥38 weeks of gestation with singletone foetus with cephalic presentation. Foetal head engagement was assessed using the rule of fifths, and participants were grouped as those with engaged head or non-engaged head. Labour was actively monitored with a partograph, and maternal and foetal outcomes were recorded. Data were collected using a standardized questionnaire and analyzed using SPSS software. Results: Among 100 nulliparous women ≥38 weeks, 69% had non-engaged and 31% had engaged foetal heads. Vaginal delivery was higher with engagement (77.42% vs 42.63%), while cesarean section was more frequent in non-engagement (57.97% vs 22.58%). Postpartum hemorrhage was higher in the non-engaged group (6.45% vs 1.45%), labour was longer, and neonatal outcomes were comparable, with APGAR scores of 7–10 in >94% of both groups and no APGAR <4. Conclusion: Non-engagement of the foetal head at term in primigravid women is common and, by itself, does not preclude successful vaginal delivery.