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4.        Management of fetal heart rate pattern changes
a.        Improving maternal circulation
b.        Improving fetal oxygenation
5.        Identification and management of variant fetal heart rate patterns
a.        Shoulders
b.        Overshoots
c.        Dysrhythmias
d.        Artifact
6.        FHR changes in response to common complications
a.        Preterm labor
b.        Hypertension
c.        Diabetes
d.        Multiple gestation
e.        Postdates pregnancy
f.        Bleeding disorders
g.        Infections
7.        Determination of fetal well being and oxygenation
a.        Uterine activity
b.        Variability
c.        Baseline rate
d.        Response to fetal stimulation
8.        Medical-legal responsibilities
a.        Midwifery practice guidelines
b.        Hospital policies
c.        State law
d.        Documentation
e.        Chain of command
9.        Case study presentations
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CERTIFICATION REVIEW BOOK FOR EFM NATIONAL EXAM 2009


Outline and Topics

1.        Physiology of blood flow
a.        Maternal systems
                1)        Respiratory
                2)        Cardiovascular
                3)        Reproductive (uterus)
b.        Fetal
                1)        Placenta
                2)        Umbilical cord
2.        Techniques of fetal assessment
a.        Auscultation
b.        Fetal movement counting
c.        Nonstress testing
d.        Contraction stress testing
e.        Biophysical profile
f.         Fetal stimulation
g.        External electronic monitoring
h.        Internal electronic monitoring
3.        NICHD pattern definitions
a.        Baseline
                1)        Normal
                2)        Tachycardia
                3)        Bradycardia
                4)        Sinusoidal
                5)        Indeterminate
b.        Periodic and episodic changes
                1)        Accelerations
                2)        Decelerations
                                a)        Early
                                b)        Late
                                c)        Variable
                                d)        Prolonged



Bibliography and Reference List

1.        American College of Obstetricians and Gynecologists (ACOG)(2008): Committee Opinion: Late-Preterm Infants. Number 404, April 2008.
2.        American College of Obstetricians and Gynecologists (ACOG)(1999): Antepartum Fetal Surveillance, Clinical Management Guidelines for Obstetrician-Gynecolog,
        Number 9, October 1999.
3.        Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) (2003): Fetal Heart Monitoring Principles and Practices, 3rd Edition.
4.        Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) (2008): Position Statement: Fetal Heart Monitoring.
5.        Gabbe, et al. (2007): Normal and Problem Pregnancies, Pub: Churchill Livingstone Elsevier.
6.        Macones, G, et al (2008): The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring: Update on Definitions,
        Interpretation, and Research Guidelines, JOGNN, 37, 510-515:2008.
7.        Menihan, C and Kopel, E (2007): Electronic Fetal Monitoring: Concepts and Applications. Pub: Lippincott.
8.        NCC Monograph (2006): Applying NICHD Terminology and Other Factors to Electronic Fetal Monitoring Interpretation, NCC, Volume 2, No. 1.
9.        Simpson, K and James, D (2008): Effects of Oxytocin-induced Uterine Hyperstimulation during Labor on Fetal Oxygen Status and Fetal Heart Rate Patterns; Am J Ob GYN,
         July 2008, p 34.e1-5.
10.      Tucker, Miller, and Miller (2008): Fetal Monitoring, A Multidisciplinary Approach, 6th Edition, Pub: Mosby.
This book has been designed for nurses, nurse midwives, and
physicians who have clinical experience with electronic fetal
monitoring and plan to take a national certification examination in
fetal monitoring. Each chapter contains a sel-assessment
examination with the answers in the final chapter. Key points are
highlighted within the text. It is a spiral-bound book. Live courses
based on this book are available by calling 401-261-4652, and have
been approved for 16 hours of continuing education time by the
California Board of Registered Nursing (#15114) and the Florida
Board of Registered Nursing for Nurses and Advanced Nurse
Practitioners.