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EFM Case Study #10: Category II FHR Management - For Nurses (1.0 contact hour - monograph)

Hours: 1.00


Best suited for: Obstetricians and family practice physicians. Midwives, obstetric nurse practitioners, residents and other interested healthcare practitioners skilled in EFM and EFM stakeholders are also welcome to participate.

Original Release Date: December 9, 2016
Review Date: June 9, 2019
Expiration Date: December 9, 2019

Description: The most frequent OB malpractice allegation, delay in the treatment of fetal distress, involves interpretation and management errors of fetal heart rate patterns (FHR). FHR patterns are divided into 3 categories based on risk of fetal acidemia by criteria outlined in the NICHD 3-Tier FHR Interpretation System. Category II is the largest category with over 128 various FHR patterns and is the most challenging to manage. Current ACOG treatment guidelines for this category are over generalized; often making clinical decision making difficult. The lack of clinical recommendations has led to inconsistent management, mismanagement, delay in management, or failed management malpractice claims. In 2013, an alternative Category II management algorithm was presented by 18 national EFM experts. This monograph compares the 2013 recommendations with the current ACOG guidelines and offers risk management solutions in the management of Category II FHR patterns. EFM Case studies and critical thinking drills are included to improve clinical decision making and reduce claims in this challenging population.

Learning Objectives: Upon completion, participants should be able to
1) Assess baseline knowledge of management of Category II FHR patterns through completion
    of critical thinking drills.
2) Critique the NICHD 3-Tier FHR Interpretation System, ACOG FHR intrapartum management
    algorithm, and a new proposal for the specific management of Category II FHR patterns.
3) Implement risk management solutions that increase your interpretation and management of
    Category II FHR patterns at highest risk for fetal acidemia and injury.

Learning Assessment: There will be a posttest for this activity with a minimum performance requirement of 8 out of 10 correct answers (80%).

Estimated time to complete activity: 60 minutes

Method and Medium: To obtain CNE credit, complete a pretest, view the entire online presentation, complete the evaluation and posttest. Once completed, a certificate will be generated for printing.

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Continuing Nursing Education Information: Successful completion of this course includes completion of the post-test with an 80% passage rate and completion of the course evaluation. This continuing nursing education program has been approved for 1 contact hour by LAMMICO/Medical Interactive. LAMMICO/Medical Interactive is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Refund Policy: If purchased, there will be no refund once the activity has been accessed.

Disclosure Policy - Read

About the Authors: Dr. Kenneth Brown - Read Bio & Carol A. Curran RNC, MS, OGNP - Read Bio

Disclosure Statement: The authors, editors and planning committee members for this activity have no relevant financial relationships to disclose.

Managing Editor: Dawer Azizi, MHA, CPHRM, LAMMICO Director of Risk Management

Editor: Sharon Cusanza MSN, RN, NEA-BC, LAMMICO Senior Risk Management Education Specialist

Content Advisors/Planning Committee Members:
Dawer Azizi, MHA, CPHRM, LAMMICO Director of Risk Management
Geri  Cook, RHIA, CPHRM, LAMMICO Senior Risk Management Specialist
Carol Curran, RNC, MS, OGNP, LAMMICO Senior Perinatal Educator and Business Specialist
Sharon Cusanza, MSN, RN, NEA-BC, LAMMICO Senior Risk Management Education Specialist
Karen Davis, MA, CPHRM, LAMMICO CME/CNE Writer/Editor
Karen Duncan, JD, RN, Legal Counsel – Medical Interactive
Karl N. Hanson, MD, FAAFP, LAMMICO Physician Consultant  
Amanda Martin-Sanchez, MEd, BSN, RN, CNOR, LAMMICO CME/CNE Educator
Elmore Rigamer, Jr., MD, LAMMICO Physician Consultant
Ruth Ryan, MSW, BSN, RN - Consultant, CME/CNE Writer

Electronic Hardware and Software Requirements - Read

Web Master Contact Information: For assistance, contact Shea Ivey at 866/398-1038 or help@medicalinteractive.com

Disclaimer: This activity is presented by LAMMICO as risk management education. It is not legal advice, nor does it establish medical standards of care. Standards of care vary depending on the unique presentation of each patient. The information contained herein is not a substitute for the reasonable discretion of skilled and informed clinicians at the point of care. Medical Interactive seeks to meet all the continuing education requirements for every state nursing board. However, the regulations in each state differ, and may change.  Before taking any course, you should confirm whether the course meets your state board's requirements for continuing education credit.

Copyright Information: Copyright © 2016


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This course is offered through Experix, a wholly owned subsidiary of Physicians Insurance, and is based on more than 30 years' experience in providing continuing medical education. This course is complimentary for Physicians Insurance members.


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