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Digital Seminar

Electronic Fetal Monitoring: A Standardized Approach


Speaker:
Rebecca Cypher, MSN, PNNP
Duration:
1 Hour 54 Minutes
Format:
Audio and Video
Copyright:
Jan 03, 2023
Product Code:
POS078548
Brochure Code:
SUM88406
Media Type:
Digital Seminar


Description

Obstetric clinicians with their knowledge and skills, remain one of most important elements in high-quality intrapartum care. Unfortunately, after several decades of clinical use, many uncertainties continue to surround intrapartum monitoring including interpretation, management, and other related decision-making processes. When clinicians are not current in fetal monitoring or do have a firm grasp of basic concepts, there is a risk for adverse maternal and neonatal outcomes.  This can have a significant negative impact on families and the healthcare system. Therefore maternal-fetal safety is of the utmost importance.  Thus, continuous learning that includes contemporary research is fundamental for patient safety and for optimizing perinatal outcomes.  An overview of fetal monitoring principles as well as updated research will be presented in this 2-hour recorded session.

Credits

Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.



* Credit Note - **

NOTE: Tuition includes one free CE Certificate (participant will be able to print the certificate of completion after passing the online post-test (80% passing score) and completing the evaluation). Instructional methods will include PowerPoint, didactic lecture, and others.

Continuing Education Information:  Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Program content is reviewed periodically per accrediting board rules for currency and appropriateness for credit. Credit approvals are subject to change. Please note, your state licensing board dictates whether self-study is an acceptable form of continuing education. Please refer to your state rules and regulations. If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. 
For other credit inquiries not specified below, please contact info@pesi.com or 800-844-8260 before purchase.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of your profession.  As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your profession's standards.  

For Planning Committee disclosures, please see the statement above.  For speaker disclosures, please see the faculty biography.


Psychologists - Psychologists & Physicians

Physicians

PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. This activity was originally recorded on 1/3/2023. It was last reviewed on 3/13/2023 and is valid until 03/13/2026.  Physicians should only claim credit commensurate with the extent of their participation in the activity. You are required to successfully complete and submit a post-test prior to receiving a certificate of completion.


Psychologists

The following state psychologist boards recognize activities sponsored by PESI, Inc. as an approved ACCME provider: Alaska, Arkansas, California, Colorado, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Pennsylvania, South Carolina and Wisconsin. This activity consists of 1.5 clock hours of continuing education instruction. You are required to successfully complete and submit a post-test prior to receiving a certificate of completion.


Midwives

CE credit is available. This self-study course consists of 1.75 continuing education credit hours for Midwives. The Certificate Maintenance Program of the American Midwifery Certification Board recognizes and accepts for continuing education credit courses that are specifically applicable and pertinent to the practice of midwifery and by entities approved by the ACCME (Accreditation Council for Continuing Medical Education). This endruing material is certified for a maximum of 1.75 AMA PRA Category 1 Credits™ by PESI as an accredited ACCME provider authorized to award credit by the AMA. PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


Nurses, Nurse Practitioners, and Clinical Nurse Specialists

PESI, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Nurses completing these self-study materials will earn 1.75 contact hours. Expires: 12/15/2025.


California Nurses

PESI, Inc. is a provider approved by the California Board of  Registered Nursing, Provider #: 17118 for 1.5 self-study contact hours. 

** You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.


Florida Nurses

PESI, Inc. is an approved provider by the Florida Board of  Nursing. Provider #: FBN2858. These materials qualify for 1.5 self-study contact hours.

CE Broker


Iowa Nurses

PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 1.75 self-study contact hours. Please email cepesi@pesi.com with your license number, include the title, speaker name and date. PESI must have this number on file in order for your hours to be valid.


Physician Assistants

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME such as PESI. Physician assistants may receive a maximum of 1.5 hours for completing this self-study program. This activity was originally recorded on 01/03/2026. It was last reviewed on 03/13/2023 and is valid until 03/13/2026

 

PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.


Other Professions

This self-study activity qualifies for 1.75 continuing education clock hours as required by many national, state and local licensing boards and professional organizations. Save your activity advertisement and certificate of completion, and contact your own board or organization for specific requirements.



Handouts/Brochure

Speaker

Rebecca Cypher, MSN, PNNP's Profile

Rebecca Cypher, MSN, PNNP Related seminars and products


Rebecca Cypher, MSN, PNNP, is owner of Maternal-Fetal Solutions, LLC, an independent consulting and education service, where she primarily focuses on assisting clinicians and hospitals to be change agents in the delivery of obstetric care. Her professional experience expands over 30 years in the perinatal arena, with 20 years on active duty, serving as a Nurse Corps officer in the United States Air Force, which included a wide variety of inpatient and outpatient obstetric settings in clinical and management positions. After military retirement, she worked as a perinatal nurse practitioner in a maternal-fetal medicine division focusing on obstetrical care and research. Rebecca served on the Board of Directors at the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) including one term as president. Rebecca is passionate about her profession and multidisciplinary education, with her attention devoted to evidence-based practice, clinical judgment, critical thinking, and collaboration within the healthcare team.


Speaker Disclosures:
Financial: Rebecca Cypher is the owner of Cypher Maternal-Fetal Solutions, LLC and a research nurse with the Amniotic Fluid Embolism Foundation. She receives a consulting fee from Clinical Computer Systems (OBIX) and royalties from Elsevier. Rebecca receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Rebecca Cypher is a member of the Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN); Sigma Theta Tau International; the Society of Maternal-Fetal Medicine, and the Society of OB/GYN Hospitalists. She additionally has professional affiliations with the American College of Obstetricians and Gynecologists Pregnancy and Postpartum Emergencies Task Force/Special Project and the Washington State Maternal Mortality Review Panel.


Additional Info

Access for Self-Study (Non-Interactive)

Access never expires for this product.

For a more detailed outline that includes times or durations of time, if needed, please contact cepesi@pesi.com  


Questions?

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Objectives

  1. Define FHR characteristics using NICHD standardized terminology.
  2. Distinguish between the 3 elements of EFM standardization.
  3. Evaluate an organized, systematic ABCD approach to FHR management.
  4. Critique research related to Category II FHR management.

Outline

 ABCD approach

  •  Assess the oxygen pathway a. Lungs, heart, vasculature, uterus, placenta, umbilical cord
  • Begin corrective measures as previously outlined
  • Clear obstacles to delivery
    • Facility
    • Staff
    • Patient
    • Fetus
    • Labor
  • Determine decision to delivery time
    • Facility response time
    • Staff
    • Surgical, medical and obstetric considerations
    • Other considerations (e.g., EFW, presentation) 

 

Terminology

  • What is it called
  • Consensus statement by NICHD
    • Adopted by AWHONN, ACOG, and ACNM
  • Interpretation
    • What does it mean
    • What information does the FHR tracing provide regarding oxygen transfer
      • Head compression, cord compression, uteroplacental dysfunction
      •  All decelerations have the exact same triggers
        • Interruption of oxygen transfer from the environment to the fetus at one or more points along the oxygen pathway
        • moderate variability and/or accelerations exclude ongoing hypoxic injury
  • Management
    • What do we do about it
    • Corrective measures
      • IV fluid bolus
      • Lateral positioning
      • Correct hypotension
      • Decrease uterine activity
      • Amnioinfusion
      • Tocolytic administration
      • Alter pushing technique
      • Oxygen administration for maternal pulse ox <96%
    • Introduction to ABCD approach to management 

ABCD approach

  • Assess the oxygen pathway
    • Lungs, heart, vasculature, uterus, placenta, umbilical cord
  • Begin corrective measures as previously outlined
  • Clear obstacles to delivery
    • Facility
    • Staff
    • Patient
    • Fetus
    • Labor
  • Determine decision to delivery time
    • Facility response time
    • Staff
    • Surgical, medical and obstetric considerations
    • Other considerations (e.g., EFW, presentation) 

“Intrapartum management of Category II FHR tracings towards standardization of care” 2013 article

  • Algorithm
  • Expert Opinions a. Not evidence based
  • Definition of Significant Decelerations
  • Key components of algorithm that are missing
    • Precise cervical dilation
    • When to notify primary clinician
      • “A standardized approach for Category II fetal heart rate with significant decelerations: Maternal and neonatal outcomes”. 2018 article
        • Prospective interventional trial: 29 hospitals
        • Comparison between 2013 expert opinion and this trial algorithm
        • Published results related to maternal and neonatal outcomes
        • Only research conducted with a research protocol 

Target Audience

  • Nurses
  • Nurse Practitioners
  • Physicians
  • Physician Assistants
  • Midwives
  • Doulas

Reviews

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