10/28/14  

1  

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

10/28/14  

2  

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

10/28/14  

3  

10/28/14  

4  

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  

10/28/14  

5  

Original (2010) Category II Algorithm

10/28/14  

6  

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.  

10/28/14  

7  

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    

10/28/14  

8  

 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

10/28/14  

9  

10/28/14  

10  

10/28/14  

11  

10/28/14  

12  

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