10/12/14  

1  

EFM: Management of Category ll Tracings

C A R O L J H A R V E Y , M S , B S N , R N C - O B , C - E F M , C S 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, identifies the correct NICHD Category and verbalizes recommended actions or inaction from the recent consensus panel.

10/12/14  

2  

Outline

I.  Introduction: Preconference Workshop 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 VI.  Case Studies and Algorithm Practice

2008 NICHD II

10/12/14  

3  

10/12/14  

4  

10/12/14  

5  

10/12/14  

6  

10/12/14  

7  

10/12/14  

8  

10/12/14  

9  

10/12/14  

10  

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.  

10/12/14  

11  

10/12/14  

12  

10/12/14  

13  

� Summary