Perinatal Quality Foundation Credentialing Examination: Fetal Heart Monitoring
Welcome to the Perinatal Quality Foundation 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 Perinatal Quality Foundation 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.
The Perinatal Quality Foundation 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.
The Perinatal Quality Foundation 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.
Please click "Next" to begin. Please use the scroll bar 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.
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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.
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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.
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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?
Drag scrollbar to the left or right to view 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?
Drag scrollbar to the left or right to view 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?
Drag scrollbar to the left or right to view entire tracing.
Example Result
Learning Objectives
- 1. Identify components and categorization of an EFM tracing using the 2008 NICHD guidelines.
- 2. Characterize the trend of a Category II tracing and assess the risk involved in associated clinical situations.
- 3. Evaluate the impact of the chosen management intervention for the Category II EFM tracing.
- 4. Assess the risk of the clinical situation involving a Category III FHR tracing.
- 5. Evaluate the impact of the chosen management intervention for the Category III FHR tracing.
