FHM Vignette #13: Multiple Patient Scenarios

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 encourage your use of critical thinking skills in an emergency situation. Fast-paced evaluation and intervention are required to save this mother and baby. The patient arrives to the emergency department with frank vaginal bleeding, abdominal pain, a challenging FHR tracing and a history of substance abuse. After completing this activity, practitioners should be able to: prioritize patient care based on the FHR tracings presented in three patient scenarios; examine the defining characteristics of a Category I FHR tracing; examine the Clark algorithm for Category II FHR tracings; and recognize the importance of maternal-fetal status and risk factors when planning safe staffing ratios.