Occiput posterior (OP) malpresentation occurs 5-12% at birth, increases risk of surgical birth, and frequently coincides with category II or III FHR patterns. In an effort to reduce cesarean births, ACOG and SMFM guidelines encourage practitioners to perform manual rotation of the fetal occiput during the second stage of labor while AWHONN encourages use of various birth positions for spontaneous rotation.
Fetal triage is not a new skill but has a significant impact on malpractice claims. Triaging EFM data to establish a course of action for the fetus happens a lot in clinical care. Our monograph provides a resource for perinatal practitioners that provides an EFM Triage model for swift and accurate EFM interpretation when there is no clinical information about the mother or her pregnancy.
Utilization of standardized electronic fetal monitoring (EFM) nomenclature nationwide remains inconsistent between hospital to hospital and practitioner to practitioner. This monograph outlines how to apply standardized EFM nomenclature, 3-Tier FHR Interpretation System and the ACOG intrapartum management algorithms into clinical practice in a case study format. EFM risk management concerns are defined..
New guidelines outlined in the ACOG & AAP Task Force Report on Neonatal Encephalopathy (NE) include scientific updates on specific fetal heart rate patterns, sentinel events, and newborn assessment indicators that may indicate an acute intrapartum hypoxic-ischemic injury that leads to NE or cerebral palsy. This monograph reviews the new guidelines in a case study format to improve application.
Both hyper- and hypoxemia can have a negative impact on a fetus and neonate. Current scientific evidence and clinical guidelines support low dose and short duration maternal oxygen therapy during intrapartum.
Inappropriate, unsafe, or lack of transport when clinically indicated increases medical-legal risk to obstetricians and hospitals. This monograph applies the ACOG & SMFM maternal levels of care and their implications on maternal and/or fetal transport into an electronic fetal monitoring (EFM) case study format.
The over treatment of women with complaints of preterm labor without objective evidence is no longer acceptable and a new care model exists. This monograph applies the ACOG and SMFM PTL management guidelines into an electronic fetal monitoring (EFM) case study format.
Miscommunication is a primary root cause of perinatal injury and death, as well as, malpractice claims. This monograph outlines miscommunication errors in three EFM case studies; analysis and critical thinking drills are included to improve EFM communication between any two perinatal providers.
Category II is the largest category with over 128 various FHR patterns and is the most challenging to manage. This course compares the current ACOG management algorithm to current scientific research regarding new approaches to Category II FHR patterns.
When interpreting FHR patterns, the presence of decelerations (late, variable, or prolonged) is an abnormal finding. Determining when to intervene once decelerations are observed is difficult. This monograph reviews the past and present science of various deceleration severity scales and offers a simple 60-Rules option to improve clinical decision making. EFM critical thinking drills are included.
Differences in clinical opinions regarding the interpretation of EFM data or other clinical factors between two perinatal practitioners can and will happen. Choosing not to share your clinical opinion when indicated or refusing to take into consideration another’s opinion into a patient’s care plan can increase malpractice risk. This monograph defines and outlines the Chain-of-Authority process; EFM critical thinking drills are included.
Poor interpretation skills can lead to EFM diagnostic inaccuracies that result in over-management, under-management, or mismanagement. This often results from a lack of knowledge regarding NICHD terms and cognitive biases. This monograph evaluates diagnostic error as it applies to EFM interpretation and intervention and the cognitive biases that impact frequency.
The 60 minutes immediately prior to birth and the first 60 minutes after, known as the “Golden Hour,” are critical. Improper care delivered during this timeframe has short- and long-term consequences. This course provides insight on how to identify a fetus who may require resuscitation and reviews current NRP guidelines with a case study and critical thinking drills.
The obstetric malpractice claim of "a delay in treatment of fetal distress" remains the number one factor in over 20% of claims from multiple PIAA resources. The key to avoiding delaying treatment to a fetus in distress is to recognize the critical nature of the fetal events and proceed with prompt notification to perinatal team members to provide much needed care.
Perinatal clinicians are frequently unaware of the equipment limitations they use routinely. Non-invasive blood pressure machines, pulse oximeters, and electronic fetal monitors have an average failure rate of 2-3%. Machines, and the human that use them, are fallible. Understanding how a piece of equipment works, anticipating limitations under certain clinical conditions, and then modifying care is necessary for a patient’s safety. Over reliance on equipment breeds errors and increases malpractice risk.