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Journal of Obstetric, Gynecologic & Neonatal Nursing

AWHONN Education Guide

Antepartum and Intrapartum Fetal Heart Rate Monitoring: Clinical Competencies and Education Guide, Seventh Edition

Introduction

The purpose of this document is to provide a fundamental framework for the core content of educational programs and clinical practicums for fetal heart rate monitoring in obstetric practice. It outlines suggested areas of competence for clinicians whose practice includes antepartum and intrapartum fetal heart rate monitoring. This document provides didactic content, core statements, and practicum options. This open-ended approach is necessary because no study suggests one ideal methodology for education, duration of the training, or prerequisites to training that best prepare the obstetric professional to obtain, interpret, and act upon fetal surveillance data. Participation in formal programs of instruction and clinical practicums offers the opportunity to enhance competence. However, achievement of competence depends on individual skills, education, training, and clinical experience. The novice-to-expert continuum is a framework for differentiating basic from advanced education, competency, and clinical practice (Benner, 1984).

Section snippets

Electronic Fetal Heart Monitoring Terminology

In 2004, The Joint Commission published Sentinel Event Alert Issue 30, Preventing Infant Death and Injury During Delivery. The Joint Commission analyzed 47 cases of perinatal death or permanent disability and found that 72% of root causes identified were related to communication issues among health care providers. The Joint Commission recommended the use of consistent fetal heart monitoring terminology among perinatal care providers as one strategy to improve communication. Health care

Didactic Content Outline

I.

Elements of antepartum fetal heart rate (FHR) assessment

A.

Goals of antepartum FHR assessment

B.

Indications, contraindications, risks, and benefits to testing

C.

Methods and interpretation

II.

Interpretation of antepartum fetal monitoring tests

A.

Nonstress test, contraction stress test, and vibroacoustic stimulation

1.

Definition of test

2.

Physiologic basis of test

3.

Test procedure

4.

Interpretation, communication, and documentation of test results

5.

Limitations of testing

6.

Patient education

7.

Plan of care

B.

Fetal biophysical profile

Didactic Content Outline

I.

Elements of FHR monitoring

A.

Goals of FHR monitoring

1.

Determine FHR characteristics and uterine activity

2.

Assess fetal well-being/oxygenation and, if intrapartum, tolerance to labor

B.

Methods of monitoring

1.

Intermittent auscultation

a.

Fetoscope

b.

Doppler ultrasound

2.

EFM

a.

External

b.

Internal

3.

Identify criteria for intermittent auscultation and EFM

II.

Physiologic basis for interpretation

A.

Extrinsic influences on FHR (physiology and pathophysiology)

1.

Maternal–fetal exchange of gases, nutrients, and substances

a.

Placenta

b.

Maternal

Learner Assessment/Ongoing Competence Validation

Instructor/preceptor evaluation and/or learner self-evaluation should be ongoing during the training period and conducted periodically after practice competence has been determined. No agreed-upon ideal method exists to enhance or measure ongoing competence of professional practice. Additionally, no data exist to define the impact of current competence validation of FHR monitoring on patient outcomes. Therefore, maintaining the quality of individual practice according to current guidelines and

Documentation

Electronic fetal monitoring findings have been given descriptive names (e.g., tachycardia; bradycardia; normal baseline; accelerations; and early, late, variable, and prolonged decelerations). Clinicians should use these descriptive terms to verbally communicate and document FHR characteristics. Detailed narrative descriptions of FHR patterns may be used when there is uncertainty about what to name a pattern. There is no evidence to support that one documentation system is clinically superior

Summary

This education guide provides a fundamental framework for developing the core content of educational programs and clinical practicums for antepartum and intrapartum FHR monitoring in obstetric practice. Educators, providers, and institutions can use this outline to individualize content for learners along the novice-to-expert continuum. This document also outlines suggested competencies and tools for evaluation. It is recognized that there is no one ideal method to enhance or measure immediate

References (8)

  • et al.

    Intrapartum management of category II fetal heart rate tracings: Towards standardization of care

    American Journal of Obstetrics & Gynecology

    (2013)

  • Practice bulletin no. 116: Management of intrapartum fetal heart rate tracings

    Obstetrics & Gynecology

    (2010)

  • AWHONN position statement: Fetal heart monitoring

    Journal of Obstetric, Gynecologic, & Neonatal Nursing

    (2018)
  • P. Benner

    From novice to expert. Excellence and power in clinical nursing practice

    (1984)

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