Safety competence promotion in secondary education - A case of the Finnish NouHätä! Programme

The Nouhätä! safety education programme has been organised in secondary schools in Finland for over 25 years. However, to date, it has not been systematically evaluated. The purpose of this quantitative survey is to provide information about good practices, benefits and limitations of the NouHätä! Programme; this has been done by answering the research question what variables explain pupils' safety competence after participating in a NouHätä! safety education programme? The results show that the best learning outcomes in safety education are achieved when training is organised in collaboration with teachers and safety experts. Practical training also seems to have a significant impact on the safety competence of pupils. The results suggest that background variables like school success and the sources of safety knowledge affect the level of pupils' safety competence. The results of the study can be used to develop the programme and other safety education programmes for children and young people.

Sense of coherence, its components and depressive and anxiety symptoms in expecting women and their partners - A FinnBrain Birth Cohort Study

OBJECTIVE

Expecting mothers with high sense of coherence (SOC) exhibit improved physical, emotional, and childbearing health. However, the dimensions of SOC and the factor structure of the SOC-13 scale during prenatal period is slightly known. Especially the differences in experiencing SOC and its components (comprehensibility, manageability, meaningfulness) among both expecting parents (mothers and fathers) is poorly understood. The association between SOC and mood disorder symptoms (depression and anxiety) during pregnancy is scarcely studied.

METHODS

The structure of the SOC-13 scale, differences in SOC experiences, and the associations between SOC and depressive and anxiety symptoms were studied in a sample of 2784 pregnant women (mothers) and 1661 men/partners (fathers) belonging to the FinnBrain Birth Cohort Study. Self-reports (SOC-13, EPDS, SCL-90: ANX) from gestational week 24 were used. Confirmatory factor analysis (CFA) and invariance testing was carried out to investigate the factorial structure of SOC-13 among both groups (mothers and fathers). Group comparisons were used to study differences in the level of SOC among mothers vs. fathers, low vs. high depression and anxiety subgroups, and multiparous vs. nulliparous mothers.

RESULTS

A two-factor model for SOC-13 consisting of comprehensibility-manageability and meaningfulness fitted the data best. Mothers reported higher levels of meaningfulness, whereas fathers reported higher levels of comprehensibility-manageability. SOC was significantly higher among fathers vs. mothers, but mothers with depressive symptoms reported higher SOC than fathers with depressive symptoms.

CONCLUSIONS

During pregnancy, SOC can be viewed as a two-dimensional (vs. one- or three-dimensional) concept, and mothers and fathers have differences in the components of SOC. Importantly, mothers vs. fathers with depressive symptoms express higher overall SOC indicating that pregnancy may relate to higher than usual SOC especially among women with psychological distress. Understanding how expecting mothers and fathers experience SOC during pregnancy, particularly in relation to depressive symptoms, helps midwives and maternity care providers to focus health promoting support more precisely.

Development and psychometric evaluation of the Emotional Intelligence Test (EMI-T) for social care and healthcare student selection

AIM

To develop an emotional intelligence (EI) test and evaluate its psychometrics for social and healthcare student selection.

DESIGN

A cross-sectional methodological design.

METHODS

The test was developed based on a systematic review and focus group interviews. Content validity was evaluated with expert panels, and preliminary psychometrics with two pilot studies. Descriptive statistics, correlations and item response theory were used.

DATA SOURCES

Search was conducted in six databases 2018. Focus group interviews were conducted with educators and professionals in 2019. Expert panels with doctoral students, researchers and educators were conducted in 2020. Pilot tests with students were conducted 2020-2021. The developed test was administered to 4808 applicants 2021.

RESULTS

The test included four subscales. Correlations support the test's theoretical structure. The items were mainly easy.

CONCLUSION

The test assesses EI objectively and comprehensively. The item-level distractor analysis can be used for further test development.

IMPACTS

Social care and healthcare students engage in clinical practice early in their studies, and these environments can be emotionally challenging. Assessing EI in student selection with adequate test can help the institutions of higher education to select the students with required abilities to succeed in the studies. The assessment of EI during student selection also provides information higher education institutions could use to develop and provide support interventions. The results may also encourage practice placements to include EI elements as learning objective. The results of this study and especially the use of IRT and detailed distractor analysis to evaluate the psychometric properties of EMI-T can benefit researchers and educators that develop or evaluate objective assessment tools with multiple choice questions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Emotional intelligence is important for students to enable professional interaction.

Adolescents’ interpersonal cognition and self-appraisal of their own anxiety in an imagined anxiety-provoking classroom presentation scenario: Gender differences

Oral class presentations are regularly assigned to adolescents, but often provoke social anxiety, due to the importance of peer approval and need to appraise oneself as normal. Also, little is known about gender differences in girls’ and boys’ interpersonal cognition and appraisals of anxiety and self in anxiety-provoking speech situations. We examined gender differences in interpersonal cognition and appraisals of anxiety in an imagined class presentation scenario in a normative sample of 687 adolescents, 14-16-years-old, from Southwest Finland. Measures included the Classroom Questionnaire of Social Anxiety and Interpersonal Cognition and the Social Anxiety Scale for Adolescents. T-tests examined gender differences in interpersonal cognition, and chi-square tests examined adolescents’ appraisals of the likelihood of their own presentation anxiety and self as anxious. Girls more frequently reported positive, and less frequently reported negative, responses toward the depicted, anxious peer than boys. Also, a higher percentage of girls predicted that becoming anxious in the situation was likely, and non-acceptance of self as anxious was more frequent among girls. Boys predicted negative overt classmate reactions (e.g., laughing) towards the depicted, anxious peer, and towards themselves more frequently than did girls. Results are discussed in the context of gender-specific development and procedures for reducing adolescent social anxiety.

Closeness, Conflict, and Culturally Inclusive Pedagogy: Finnish Pre- and In-service Early Education Teachers’ Perceptions

This study explored the factorial and concurrent validity of a scale developed for assessing teachers’ self-efficacy beliefs in engaging with diversity in early childhood education settings. According to tests of measurement invariance, the conceptualization of the constructs varied to some extent between Finnish student teachers and qualified teachers. Qualified teachers reported, at the item level, higher confidence in engaging with diversity in mainstream early childhood classrooms than student teachers. Structural equation modeling demonstrated that for both groups, higher levels of reported confidence in planning and implementing inclusive teaching–learning interactions were related to a higher level of closeness during interactions with children. The evidence for concurrent validity may imply beneficial and reciprocal influences between teachers’ confidence in their professional competence and close teacher–child relationships. The implications of the study are discussed from the perspective of teacher training and professional development in the early childhood education context.

How do gender, Internet activity and learning beliefs predict sixth-grade students’ self-efficacy beliefs in and attitudes towards online inquiry?

Today’s students search, evaluate and actively use Web information in their school assignments, that is, they conduct an online inquiry. This current survey study addresses sixth-grade students’ self-efficacy beliefs in and attitudes towards online inquiry, and to what extent free-time and school-related Internet activity, gender and learning beliefs explain these. The questionnaire was administered in 10 schools to 340 sixth-graders in Finland. Exploratory and confirmatory factor analyses revealed three elements of self-efficacy beliefs: self-efficacy in Web searching, the evaluation of sources and synthesising information. Furthermore, attitudes towards online inquiry loaded into two factors: a positive and a negative attitude towards online inquiry. A structural equation model was used to analyse the effects of the explanatory variables on the factors. The results of this work suggest that gender and free-time Internet use predict most sixth-graders’ self-efficacy beliefs in and attitudes towards online inquiry.

Nursing applicants' reasoning skills and factors related to them: A cross-sectional study

BACKGROUND

The assessment of reasoning skills is recommended in undergraduate nursing student selection. Reasoning skills are crucial for sound decision-making, improving patient safety and are necessary from the very beginning of studies. Nursing applicants' reasoning skills based on the reasoning process have not been previously measured.

OBJECTIVES

To assess undergraduate nursing applicants' reasoning skills and factors related to them.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Undergraduate nursing applicants (n = 1056, response rate 55.4%), who consented to the study and performed a joint electronic entrance examination to six Finnish Universities of Applied Sciences in spring 2019, participated in the study.

METHODS

The Reasoning Skills (ReSki) test, based on the steps of the reasoning process, was used, comprising three question sections (collecting information, processing information, and identifying the problem and establishing goals). Background variables were collected through a questionnaire and the Positive System Usability Scale (P-SUS). The data were analysed with descriptive statistics, Pearson correlation coefficients and analysis of covariance with Tukey's test in post-hoc multiple group comparisons.

RESULTS

Applicants' total reasoning skills mean scores were above the centre of the range of possible scores (2.72/4.5, SD = 0.80). The applicants scored higher in collecting and processing information than in identifying the problem and establishing goals. Standard deviations demonstrated variance between the applicants' ability. Age, gender, and previous education were statistically significantly related to applicants' reasoning skills. Previous work experience was statistically significantly related to success only in the step of identifying the problem and establishing goals.

CONCLUSIONS

Nursing applicants' reasoning skills vary in the student selection phase. Applicants are less able to identify the problem and establish goals than to collect and process information. Vocational education does not necessarily develop adequate reasoning skills and thus prepare students for higher education studies. The results have implications for educational institutions and further research.

Teachers’ Relationships with Children in the Finnish Early Childhood Education Context: A Validation Study

This study examined the factorial validity and measurement invariance of the Student–Teacher Relationship Scale–Short Form (STRS-SF), modified by Whitaker et al. (2015) , in the Finnish Early Childhood Education (ECE) context. Confirmatory factor analysis (CFA) supported the two-factor model of Closeness and Conflict after some item modifications and partial strong measurement invariance across ECE student teachers and two qualified ECE teacher groups. In general, the participants perceived high levels of closeness and low levels of conflicts with children. The qualified teachers who voluntarily enrolled in training to improve their professional competence perceived their relationships with children as more conflictual, reported less working experience, and had younger children in their classrooms, compared to the other qualified teachers. The student teachers perceived less closeness than the teachers but reported fewerconflicts than the teachers enrolled in training. This study extended the application of the STRS-SF in teacher education and research to a Nordic cultural context.

Development and psychometric testing of Reasoning Skills test for nursing student selection: An item response theory approach

AIMS

To develop and psychometrically test the Reasoning Skills (ReSki) test assessing undergraduate nursing applicants' reasoning skills for student selection purposes.

DESIGN

A methodological cross-sectional design was applied for the psychometric testing.

METHODS

The ReSki test was developed as part of a wider electronic entrance examination. The ReSki test included a case followed by three question sections assessing nursing applicants' reasoning skills according to the reasoning process. Item response theory was used for psychometric testing to assess item discrimination, difficulty and pseudoguessing parameters. The ReSki test was taken by 1056 nursing applicants in six Finnish Universities of Applied Sciences (28 May 2019).

RESULTS

In the development process, the expert evaluations indicated acceptable content validity. In the psychometric testing, the test reliability was supported by item variance, the theoretical structure was supported by the correlation coefficients and the applicant mean performance supported an acceptable overall test difficulty. The item response theory indicated variance between the items' difficulty and discrimination ranges. However, most of the wrong items failed at being functional distractors.

CONCLUSION

The ReSki test is a new and valid objective assessment of undergraduate nursing applicants' reasoning skills. The item response theory provided item-level information that can be used for further development of the test, especially related to the revisions needed for the distractor items to achieve the desired level of difficulty.

IMPACT

What problem did the study address? The assessment of nursing applicants' reasoning skills is suggested, but there is a lack of admission tools. What were the main findings? The results provided support for the reliability and validity of the ReSki test. Item response theory indicated the need for further item-level improvement. Where and on whom will the research have an impact? The results may benefit higher education institutions and researchers when developing a test and/or student selection processes.

Seeing beyond variables: applying a person-centered approach to identifying regulation strategy profiles among Finnish preclinical medical and dental students

BACKGROUND

High-quality learning during medical school and beyond requires appropriate study strategies and taking responsibility for one's studies, thus self-regulation of one's learning. In contrast to traditional studies focusing on a variable-centered approach, a person-centered approach to regulation strategies was utilized.

METHODS

The participants were 162 Finnish medical and dental students who answered the regulation scale of the Inventory of Learning Styles at three measurement points. First, the functionality of the scale was analyzed in Finnish medical education context. Latent profile analyses were used to examine regulation strategy profiles. Last, the connections of these profiles with the study success were investigated.

RESULTS

The analyses yielded a three-factor solution, which was reliable across time. Four profiles of regulation strategies were identified and they were found to be connected to study success: Students with the lowest self-regulation and increasing lack of regulation performed worse than the other groups.

CONCLUSION

The use of a person-centered approach along with variable-centered approach increases understanding of the complex nature of learning in higher education. Person-centered approach could be used as a tool for supporting student learning and to help early diagnosing of learning difficulties, since it enables individualization of students with different regulation strategy profiles.

The developmental trajectory of perceived self-regulation, personal interest, and general achievement throughout high school: a longitudinal study

BACKGROUND

Our interest in perceived self-regulation of learning arose in the context of educational reform. After decades of stability, the Finnish high school system underwent reform in the 1990s, with a significant emphasis being placed on promoting student self-regulation of learning.

AIMS

The purposes of the study were (1) to evaluate changes in the mean level of perceived self-regulation throughout high school and (2) to evaluate the nature of the developmental relations between achievement, perceived self-regulation, and personal interest.

SAMPLE

The participants consisted of 245 systematically sampled high school students from a mid-sized Finnish city.

METHODS

T tests for paired samples were employed to assess changes in the level of personal interest and perceived self-regulation. Analysis of the developmental relations was carried out within a structural equations modelling framework.

RESULTS

The main result was that perceived self-regulation at the beginning of high school predicted not only scholastic achievement at the end of high school over and above prior achievement, but also subsequent personal interest. Additionally, following an international trend, the level of perceived self-regulation decreased from the first to third year of study.

CONCLUSIONS

The study has important theoretical and practical implications. First, the results suggest that perceived self-regulation and personal interest are only partially explained by achievement. Second, it appears that perceived self-regulation drives personal interest, not the other way around. Finally, ways for teachers and schools to sustain perceived self-regulation throughout the high school years are discussed.

Social Anxiety Scale for Adolescents (SAS-A): measuring social anxiety among Finnish adolescents

The aim of this study was to investigate symptoms of social anxiety and the psychometric properties of the Social Anxiety Scale for Adolescents (SAS-A) among Finnish adolescents, 13-16 years of age. Study 1 (n = 867) examined the distribution of SAS-A scores according to gender and age, and the internal consistency and factor structure of the SAS-A. In a subsample (n = 563; Study 2) concurrent and discriminant validity of the SAS-A were examined relative to the Social Phobia Inventory and the Beck Depression Inventory. Test-retest stability was examined over a 30-month period by repeated measures every 6 months in another subsample (n = 377; Study 3). Results mostly revealed no gender differences in social anxiety, except that boys reported more general social avoidance and distress than girls. Older adolescents (14-16-year-olds) reported higher social anxiety than younger adolescents (12-13-year-olds). Internal consistency for the SAS-A was acceptable for both genders and for all three SAS-A subscales. Confirmatory factor analysis replicated the original 18-item three-factor structure of the SAS-A, accounting for 61% of the variance between items. Evidence for concurrent and discriminant validity was found. Test-retest stability over 6 months was satisfactory. Results support the reliability and validity of the Finnish adaptation of the SAS-A, and further indicate that gender differences in adolescents' social anxiety may vary across Western countries.

Malpresentations--impact on mode of delivery

Fetal malpresentation, including persistent occipitoposterior position, is a major cause of dystocia resulting in obstetric interventions. We studied malpresentation among 11 957 consecutive singleton deliveries from 1995 to 2004. There were 1 030 deliveries with a malpresentation (8.6%). Cephalic malpresentations occurred in 5.4% of deliveries (persistent occipitoposterior 5.2%, face 0.1%, brow 0.14%), and 3.1% had breech presentation and 0.12% a transverse lie. The odds ratios (OR) for cesarean section were 14.89 (95%CI 11.91-18.63) in breech presentation and 4.57 (95% CI 3.85-5.42) in persistent occipitoposterior presentation. With persistent occipitoposterior position, the OR for instrumental vaginal delivery was 3.84 (95%CI 3.14-4.70). Primiparity was associated with increased malpresentation risks, as 54.6% of those with malpresentations were primiparous compared with 41.7% of those without (OR 1.68, 95%CI 1.48-1.91, p < 0.001). Primiparous women required more cesarean sections (OR 1.92, 95%CI 1.50-2.47) and instrumental deliveries (OR 2.89, 95%CI 1.50-2.47). Malpresentation frequently leads to cesarean section or instrumental delivery, especially among primiparous women.

Repeatability (test-retest variability) of refractive error measurement in clinical settings

PURPOSE

To estimate the repeatability of refractive error measurement (REM) in a clinical environment in cataractous, pseudophakic and healthy eyes.

METHODS

The refractive error of patients referred for cataract surgery or consultation measured by ophthalmic professionals was re-examined and the measurement results were compared. A total of 99 eyes from 99 persons (41 cataractous, 36 pseudophakic and 22 healthy eyes) with visual acuity (VA) of 0.3-1.3 (logMAR 0.52 to - 0.11) were included. The differences between measurements 1 and 2 were calculated as 3-dimensional vector values and spherical equivalents (SEs) and expressed as the coefficient of repeatability (CR). The mean time interval between the first and second examinations was 45 days.

RESULTS

The CRs for all eyes for vertical (V), torsional (T) and horizontal (H) vectors were 0.74 D, 0.34 D and 0.93 D, respectively. The CR of SE for all eyes was 0.74 D. Eyes with lower VA (0.3-0.45) had larger variability in vector and SE values but the differences between VA groups were not statistically significant. The difference in the mean defocus equivalent (DE) between measurements 1 and 2 was, however, significantly greater in the group with lower VA. In all VA groups the mean difference vector was very close to the zero vector, which means that there was no systematic difference.

CONCLUSIONS

Repeatability of refractive error measurements in clinical settings has a certain degree of variability. In this series, the variability in eyes with better VA was not great and was in accordance with earlier findings in healthy eyes. Eyes with lower VA had greater variability due to greater tolerance to defocus. Thus, conclusions concerning changes in the refractive state and the need to make changes in the refractive correction of eyes with poorer vision should be made with caution.

Random measurement error in visual acuity measurement in clinical settings

PURPOSE

To estimate the random measurement error in visual acuity (VA) determination in the clinical environment in cataractous, pseudophakic and healthy eyes.

METHODS

The VAs of patients referred for cataract surgery or consultation by ophthalmic professionals were re-examined and the VA results for distance using projector acuity charts were compared. Refractive errors were also remeasured. A total of 99 eyes (41 cataractous, 36 pseudophakic and 22 healthy eyes) were examined. The healthy comparison group consisted of hospital staff. Only one eye of each person and eyes with Snellen VAs of 0.3-1.3 (logMAR 0.52 to - 0.11) were included. The mean time interval between the first and second examinations was 45 days.

RESULTS

The estimated standard deviation of measurement error (SDME) of repeated VA measurements of all eyes was logMAR 0.06. Eyes with the lowest VA (0.3-0.45) had the largest variability (SDME logMAR 0.09), and eyes with VA > or = 0.7 had the smallest (SDME logMAR 0.04). The variability may be partly explained by the line size progression in lower VAs, partly by the difference in the remeasurement of the refractive error. The difference in the average VA between examinations 1 and 2 (logMAR 0.15 versus 0.12) was considered to be of some interest because it indicates that some learning effect is possible.

CONCLUSION

Visual acuity results in clinical settings have a certain degree of inherent variability. In this series variability ranged from SDME logMAR 0.04 (eyes with good vision) to logMAR 0.09 (in the lower vision group) in the Snellen VA range of 0.3-1.3. Changes should be judged with caution, especially in cases of decreased VA.

Recurrent persistent occipito-posterior position in subsequent deliveries

A nine year follow up study of the delivery pattern of 119 women after delivery in the persistent occiput posterior position and their occipito-anterior controls. The studied parameters were: number of deliveries, number of repeated cases of persistent occiput posterior position and operative deliveries. Deliveries in the occipito-posterior position were more common in the study group than in the controls (P= 0.031). Except for this, no statistically significant differences were found between the groups. According to the results, recurrence of the persistent occiput posterior position is common. A history of delivery in the persistent occiput posterior position does not seem to have any major impact on future childbearing.

Perioperative stroke in coronary artery bypass patients

BACKGROUND AND AIMS

Stroke has remained one of the most frustrating complications in coronary artery bypass surgery (CABG). The purpose of this study was to describe the incidence and correlates of stroke in CABG patients operated on in a hospital with low annual volume of open-heart surgery procedures. The aim was moreover to clarify subsequent outcome and self-reported satisfaction-based quality of life of patients who had experienced a stroke.

MATERIAL AND METHODS

The material was a cohort of 1318 consecutive CABG patients operated on over a 6-year period. Data was collected prospectively but the final analysis was retrospective. Questionnaires supplemented the estimation of survival and subsequent functional status.

RESULTS

The incidence of stroke was 2.6 %. Age > 70 years, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), cerebral vascular disease (CVD), number of aortic anastomoses and significant atherosclerosis of the ascending aorta were univariate predictors of stroke. Postoperative stroke was experienced in 55.9% of cases delayed appearing from 2nd postoperative day on. Stroke patients had a higher rate of mortality (14.7% vs. 1.0%, p = 0.001) and poorer survival than no-stroke patients (82.4% and 97.4% at one year and 61.2% and 89.7% at six years, p < 0.001).

CONCLUSIONS

The incidence of stroke seems to be on the same level in CABG patients from a low volume hospital as in reports from centres with a high volume of annual procedures. Stroke predicts higher mortality, longer intensive care unit (ICU) stay, longer hospitalisation and poorer survival. A relatively high number of stroke patients need permanent institutional care. Satisfaction-based quality of life in CABG patients also remains on a lower level in comparison to patients without neurological complications.

Peripheral vascular disease as predictor of outcome after coronary artery bypass grafting

BACKGROUND AND AIMS

Understanding and objective assessment of risks is crucial in cardiac surgery. The aim of this study was to assess the influence of peripheral vascular disease (PVD) on morbidity, mortality and outcome in coronary artery bypass grafting (CABG) patients.

MATERIAL AND METHODS

The ankle-brachial pressure index (ABPI) was used as indicator of PVD and was measured in 178 CABG patients. Two groups were established: 1. normal ABPI (0.9-1.3) (n = 136) and 2. lowered ABPI (< 0.9) (n = 35). The mean follow-up was 26 months.

RESULTS

The presence of PVD was 20.5 %. Patients with PVD were older (p < 0.05), more often of female sex (p < 0.05), had higher Higgins's risk score (p = 0.001) and more often intermittent claudication (IC) (p < 0.001). PVD significantly predicted atrial fibrillation (FA) (p < 0.05) and relatively postoperative myocardial infarction (MI) (p = 0.058).

CONCLUSIONS

The presence of PVD is relatively high in CABG patients and increases with age. PVD predicts some morbidity but seems to have fairly little influence on short-term or middle-term outcome of CABG patients. ABPI may be of only limited value in identifying patients with high operative risk in CABG.

Use of obstetric forceps in Finland today--experience at Vaasa Central Hospital 1984-1998

BACKGROUND

Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital.

METHODS

A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section.

RESULTS

There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome.

CONCLUSIONS

Forceps delivery appears to be a safe alternative in our setting.

Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries

OBJECTIVE

To use intrapartum sonography as a tool to investigate the development of the persistent occiput posterior position during labor, as well as to identify parameters correlating with the outcome of labor.

METHODS

A prospective study of 408 women in labor after 37 weeks' gestation with a singleton fetus in a vertex position using sonography at the onset of labor was performed. Fetal position, placental location, and maternal BMI (body mass index) were recorded. Outcome of labor was monitored for all relevant parameters.

RESULTS

Most (68%) of persistent occiput posterior positions develop through a malrotation during labor from an initially occipitoanterior position. Only 32% of persistent cases were occipitoposterior (dorsoposterior) at the onset of labor; operative interventions were required in 87.5% of these. Of the 61 (15%) occipitoposterior positions at the onset of labor, 53 (87%) rotated into an occiput anterior position. Persistent occiput posterior position was more common in the initially occipitoposterior group (P < 0.01, Fisher exact test), and posterior placental locations were fewer (z test, P = 0.05). Also, operative deliveries were more common in the group remaining occipitoposterior throughout labor (P < .01, Fisher exact test). A higher maternal BMI correlated with neonatal weight (P < .01, Pearson correlation), an increase in operative deliveries (P = .032, Pearson correlation), lower Apgar scores at 1 minute (P = .02, Spearman correlation), and increase in posterior placental locations (P = .037, two-tailed t test).

CONCLUSION

In most cases, persistent occiput posterior position develops through a malrotation and only in a little more than one-third of cases through absence of rotation from an initially occipitoposterior position. Higher maternal BMI correlates with higher fetal weight, increased operative deliveries, lower Apgar scores at 1 minute, and posterior placental locations. Intrapartum sonography proved to be useful in investigating the development of the persistent occipitoposterior position.