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Fetal Heart Monitoring: Management of
Category ll Tracings
C A R O L J H A R V E Y , R N C , M S , R N C - O B , C - E F M
C A R O L J H A R V E Y C O N S U L T I N G , L L C A T L A N T A , G A
& C L I N I C A L S P E C I A L I S T W O M E N ’ S S E R V I C E S
N O R T H S I D E H O S P I T A L A T L A N T A – C H E R O K E E – F O R S Y T H
G E O R G I A
OBJECTIVES
At the end of the presentation, the participant will be able to 1. Correctly identify the three types of decelerations included in the U.S. National Institutes of Child Health and Human Development (NICHD) 2008 Nomenclature Update for Electronic Fetal Monitoring (EFM).
2. Discuss the rationale for the NICHD’s three (3)-‐category system to classify EFM tracings.
3. When given an EFM tracing, identiNies the correct NICHD Category and verbalizes recommended actions or inaction from the recent consensus panel.
AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
C o n f l i c t s o f I n te r e s t
I h ave n o c o n f l i c t s o f in te r es t w i th a ny o f th e ma te r i a l p r esen ted i n to d a y ’s wo r k sh o p.
P l e a s e N o t e -
• Pr i n c i p a l , C a r o l J Har vey C on su l t i n g, L L C – Hea l thca r e Co nsu l t in g a nd E d u c a t i o n B u s i n e ss . Of f e r s C o u r se s i n E FM f r o m
“B as i c” to “Mas te r s” L eve l .
Carol Harvey
AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
Thank you: Susan Drummond, MSN, RNC
SPECIAL THANKS TO SUSAN DRUMMOND WHO GENEROUSLY
SHARED HER SLIDES AND IDEAS FOR THIS PRESENTATION
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ACOG DISTRICT II NEW(!) EFM TOOLKIT
AND TO LISA MILLER, MSN, CNM, C-
EFM &
DAVID MILLER, MD
Thank you:
AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
MANAGEMENT OF CATEGORY II EFM TRACINGS Review of NICHD 2008 and Principles of Fetal Physiology
AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
NICHD 2008 JOGNN: http://onlinelibrary.wiley.com/store/10.1111/j.1552-6909.2008.00284.x/asset/j.1552-6909.2008.00284.x.pdf?v=1&t=i1pruaa3&s=e97e82b1905cd67770ae4d8b22da0630a2be6397
Obstetrics & Gynecology. 112(3):661-‐666, September 2008. JOGNN, 37, 510-‐515; 2008.
2008 NICHD – Other sources • http://dbbs.wustl.edu/curstudents/Documents/Markey/2008%20NICHD%20EFM%20_%20Macones.pdf
• http://onlinelibrary.wiley.com/store/10.1111/j.1552-6909.2008.00284.x/asset/j.1552-6909.2008.00284.x.pdf?v=1&t=i1ps29gj&s=e8f4e7f3bb09efd95a69f70acec32e3fdadf0afc
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AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
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Original (2010) Category II Algorithm
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Clark, et al; Intrapartum Management of Category II Fetal Heart Rate Tracings –
Institutions Represented
(a) Hospital Corporation of America, Nashville, TN (b) Vanderbilt University, Nashville, TN (c) Long Beach Memorial Hospital, Long Beach, CA (d) University of California, Irvine, CA (e) University of Southern California, Los Angeles, CA (f) University of California, San Francisco, CA (g) Mercy Hospital, St. Louis, MO (h) Baylor College of Medicine and Texas Children's Hospital, Houston, TX (i) University of Texas, Houston, TX (j) University of Texas Medical Branch, Galveston, TX (k) New York Presbyterian/Columbia University, New York, NY (l) Winthrop University Hospital, Mineola, NY (m) Brown University and Women and Infant's Hospital of Rhode Island, Providence, RI (n) Medical University of South Carolina, Charleston, SC (o) Perinatal Risk Management and Consultation Services, Portland, OR
American Journal of Obstetrics & Gynecology. 209(2):89-‐97, August 2013.
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AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
Case Presentations
Strip 1 of 2 Strip 2 of 2
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Next Step …
AGENDA
I. Introduction II. Quick Review of NICHD 2008 Nomenclature
I. Self-‐test your knowledge II. Physiologic principles for common EFM tracings
III. Using the Category Framework IV. Category II Tracings V. Selecting and Using a Recommended
Intervention Algorithm(s) VI. Challenges and Opportunities
FHR monitoring consists of three components:
Or, in common terms …
Terminology – What do I call it? Interpretation – What does it mean? Management – What do I do about it?
EFM
Intrapartum FHR monitoring interpretation is intended to assess fetal oxygenation during labor
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H T T P : / / M A I L . N Y . A C O G . O R G / W E B S I T E /E F M P O S T E R . P D F
Download!
hMp://www.acog.org/About-‐ACOG/ACOG-‐Districts/District-‐II/EFM-‐eToolkit
SUMMARY