Fetal Monitoring Credentialing

Welcome

Welcome to the Inteleos Credentialing Examination for Fetal Heart Monitoring. This assessment focuses on the role of electronic fetal monitoring in the management of women in labor. You will be asked to apply your judgment in the management of clinical cases and to demonstrate your knowledge of current guidelines. This credentialing examination will be open to physicians, midwives, nurse-midwives, nurses, and others involved in management of labor and delivery patients.

The Inteleos Credentialing Examination allows participants to demonstrate knowledge and judgment of fetal heart rate monitoring principles defined by national consensus. Leading experts in the United States have been involved in development of this credentialing examination.

Inteleos is committed to improving the quality of obstetrical medical services by providing state-of-the-art educational programs, and evidence-based, statistically valid monitoring systems to evaluate current practices and facilitate the transition of emerging technologies into clinical care.

Inteleos recognizes that certain abnormal fetal heart rate changes in labor may be associated with long term sequelae in the newborn. Standardized language, knowledge, and protocols related to fetal heart monitoring contribute to fetal safety.

Select "Next" to begin. Use the horizontal scroll area under each fetal strip to view the full tracing.

Knowledge Question Tutorial

Knowledge questions assess your base knowledge in electronic fetal monitoring. These questions often include a fetal monitor tracing, a clinical scenario, or both.

Knowledge questions have a clear, correct answer.

Knowledge questions can be multiple-choice, or multi-select. They have a clear, correct answer, and they're scored traditionally. You'll receive no credit for an incorrect answer and full credit for a correct answer.

Judgment Question Tutorial

Judgment questions assess your clinical decision making. They differ from knowledge questions in a couple of important ways.

In judgment questions, you'll see a clinical scenario where an initial management decision has been made.

Next, you'll see a new piece of information. You'll decide how this new information affects the initial management decision.

Select "Next" for more detail on how judgment questions work.

Judgment Question Tutorial – Rain/Umbrella Scenario

To understand how judgment questions work, let's look at a simple example. The morning weather report predicts a 40% chance of rain. Based on that, your initial decision is that you won't need an umbrella. But then you open your front door and see heavy, dark clouds.

Does seeing the clouds suggest that your initial decision is completely validated, possibly validated, not affected at all, possibly invalidated, or completely invalidated?

In judgment questions, more than one answer could be acceptable.

More than one of these options could be acceptable. In this example, most meteorologists would answer "possibly invalidated," but some may answer "completely invalidated." Your answers to judgment questions are given a weighted score, based on how an expert panel answered the same question.

Sample Question: 1 of 6

Indicate the number of accelerations shown on this FHR tracing belonging to a term fetus. Select the best answer.

0

1

2

3

Fetal heart rate tracing for sample question 1 — Scroll horizontally to view the entire tracing.

Sample Question: 2 of 6

A 35-year-old G2P1001 at 37 weeks' gestation is being induced with oxytocin for oligohydramnios. Her cervical exam is 4/-2/70%/vertex, and she has just received an epidural.

Which of the following could result in this fetal tracing? Select the best answer.

Chronic uteroplacental insufficiency

Epidural-induced maternal hypotension

Tachysystole

Any of these etiologies may contribute

Fetal heart rate tracing for sample question 2 — Scroll horizontally to view the entire tracing.

Sample Question: 3 of 6

A 19-year-old G2P1001 patient is at 6 cm dilation and making good progress in labor with prolonged rupture of membranes. She has developed a fever of 102°F and is now on antibiotics and acetaminophen.

Which of the following statements is accurate in this case? Select all that apply.

Maternal fever in the presence of fetal tachycardia does not necessarily require cesarean delivery.

If there is fetal tachycardia which persists, the fetus is in imminent danger of developing heart failure.

Cesarean delivery will prevent the fetus from developing sepsis.

Fetal tachycardia plus minimal variability does not necessarily indicate fetal acidosis.

Fetal heart rate tracing for sample question 3 — Scroll horizontally to view the entire tracing.

Sample Question: 4 of 6

Case Context

A 32-year-old G2P1001 patient at 39 weeks is admitted with complaints of vaginal bleeding. Her cervical exam is 9/+1/90%/vertex/intact.

Your initial assessment is...

A placental abruption, which may require a cesarean delivery

...and then you learn this additional information:

The FHR tracing shown below.

How does this additional information affect your thinking about the initial assessment?

Strongly invalidates

Could invalidate

No impact

Could support

Strongly supports

Fetal heart rate tracing for sample question 4 — Scroll horizontally to view the entire tracing.

Sample Question: 5 of 6

Case Context

A 25-year-old G1P0 patient presents at 41 weeks in spontaneous labor. Ruptured membranes are confirmed and the initial cervical exam is 3/+1/100%/vtx. The initial FHR tracing is shown in Panel A.

Your management plan is...

Continue FHR monitoring and expectantly manage

…and then you learn the following additional information:

2 hours later, you review the FHR tracing shown in Panel B and note that the cervix is unchanged.

How does this additional information affect your thinking about the management plan?

Strongly invalidates

Could invalidate

No impact

Could support

Strongly supports

Fetal heart rate tracing for sample question 5 — Scroll horizontally to view the entire tracing.

Sample Question: 6 of 6

Case Context

A 28-year-old G3P1102 patient at 38 weeks is admitted in active labor with an initial cervical exam of 6/-1/80%/vertex/intact. An epidural is in place. Her FHR tracing is shown in Panel A.

Two hours later, the nurses call you with concern about decreased variability in the FHR tracing. They have employed conservative measures including oxygen and position change, and are performing fetal scalp stimulation.

Your initial assessment is...

Fetus could be acidotic.

…and then you learn the following additional information:

You arrive at the hospital and review the FHR tracing shown in Panel B.

How does this additional information affect your thinking about the initial assessment?

Strongly invalidates

Could invalidate

No impact

Could support

Strongly supports

Fetal heart rate tracing for sample question 6 — Scroll horizontally to view the entire tracing.