Perinatal Quality Foundation Credentialing Examination: Fetal Heart Monitoring (EFM)

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 obstetrical cases. 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 is open to physicians, 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 Maternal – Fetal Medicine 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 fetal intolerance to labor may have long-term sequelae. Standardized language, knowledge, and protocols related to fetal heart monitoring contribute to fetal safety.

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Knowledge Question Tutorial

Knowledge questions assess your base knowledge in electronic fetal monitoring. These questions often include a fetal monitor strip, 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 forty-percent 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

Which of the following best describes the decelerations in this EFM tracing?

fetal strip

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 4/70/-2/vertex, and she has just received an epidural.

Which of the following could result in this fetal tracing?

fetal strip

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 degrees F and is now on antibiotics and acetaminophen. Which of the following statements is accurate in this case? Select one or more correct answers.

fetal strip

Sample Question: 4 of 6

Case Context:

You are asked to identify the category of a FHR tracing.

You are looking for …

Category I

…in the tracing:

The tracing below.

How would you qualify your decision of whether this category is present?

fetal strip

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?

fetal strip

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.

2 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?

fetal strip

Example Result

pqf sample results

Learning Objectives

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