FHM Vignette #06: 36-Week Twins/Anaphylaxis of Pregnancy

Course overview

Training on reading FHR monitor strips is often not applied to specific clinical situations or to an understanding of why the FHR patterns look as they do in those situations. This activity reviews FHR patterns and highlights useful information for practitioners who interpret fetal tracings. The basic steps in FHR monitor strip interpretation include: 1) accurate assessment of the FHR pattern using the standardized NICHD terminology; 2) accurate assessment of maternal uterine activity; 3) consideration of maternal/fetal physiology as it relates to the current clinical situation; 4) determination of the appropriate FHR category; and 5) intervention and management appropriate to tracing interpretation. In this activity, we review a complicated twin pregnancy scenario and its challenges. During the patient's labor, a profound obstetrical emergency arises that impacts maternal and fetal outcome. The OB stat team and other medical disciplines are called into immediate action in order to save mother and babies. The outcome is less than optimal, and the question of "What could we have done better?" lingers at the conclusion of this case. Staff debriefing and case review are essential for analysis and critique of this emergency situation and outcome in order to help to provide clarity for future process improvement. After completing this activity, practitioners should be able to: identify signs and symptoms of anaphylaxis of pregnancy; list critical actions of response to life-threatening anaphylaxis of pregnancy; define twin-to-twin transfusion syndrome; and recognize a distinct FHR change demonstrating acute onset of fetal hypoxia.