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Partnership Improves OB Safety in New York State
By Kathleen Ciccone, RN, MBA; Christa R. Christakis, MPP; Andrea Mathis, MPH; and Patricia Montone Charvat

Fetal Heart Rate Monitoring During Labor
Patient Education Pamphlet

Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles
ACOG Practice Bulletin Number 106

Quality Improvement Ideas
HANYS Quality Institute


Free Category II Management Online App


A Collaborative Interdisciplinary Approach to Electronic Fetal Monitoring: Report of a Statewide Initiative
Miller, Lisa A. CNM, JD; Miller, David A. MD, Journal of Perinatal & Neonatal Nursing. 2013 Apr/June; Vol 27(2):126–133.

A framework for standardized management of intrapartum fetal heart rate patterns.
Parer JT, Ikeda T, Am J Obstet Gynecol. 2007 Jul;197(1):26.e1-6.

Cognitive Errors (Can They Be Prevented?).
Hurst JW. Am J Cardiol. 101(10):1513-7; 2008.

Electronic fetal heart rate monitoring: research guidelines for interpretation.
National Institute of Child Health and Human Development Research Planning Workshop, Am J Obstet Gynecol. 177:1385-90; 1997.

Elevated uterine activity increases the risk of fetal acidosis at birth.
Bakker PC, Kurver PH, Kuik DJ, Van Geijn HP, Am J Obstet Gynecol. 2007 Apr;196(4):313.e1-6.

Eliminating birth trauma at Ascension Health.
Mazza F, Kitchens J, Kerr S, Markovich A, Best M, Sparkman LP. Jt Comm J Qual Patient Saf 33(1):15-24, 2007.

Fetal acidemia and electronic fetal heart rate patterns: is there evidence of an association?
Parer JT, King T, Flanders S, Fox M, Kilpatrick SJ.  J Matern Fetal Neonatal Med. 19(5):289-94; 2006.

Fetal Monitoring Bundle.
Howard Minkoff, MD, and Richard Berkowitz, MD.

Fetal Heart Rate Monitoring Update: The Good, the Bad, and the Atypical.
Ashmead, GG. The Female Patient 36:14-22; 2011.

Intrapartum Fetal Heart Rate Monitoring: A Standardized Approach to Management
Miller, David.  Clinical OBGYN 54(1):22-27;2011.

Intrapartum Fetal Monitoring: Maximizing Benefits and Minimizing Risks.
Miller, David.  Contemporary OBYGN 55(2), 2010.

Overconfidence as a cause of diagnostic error in medicine.
Berner ES, Graber ML. Am J Med. 121(5 Suppl):S2-23; 2008.

Reducing obstetric litigation through alterations in practice patterns.
Clark SL, Belfort MA, Dildy GA, Meyers JA. Obstet Gynecol. 112(6):1279-83, 2008.

Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring.
Neilson DR Jr, Freeman RK, Mangan S. Am J Obstet Gynecol. 198(6):717-24, 2008.

System errors in intrapartum electronic fetal monitoring: a case review.
Miller LA. J Midwifery Womens Health. 50(6):507-16; 2005.

The human factor: the critical importance of effective teamwork and communication in providing safe care.
Leonard M, Graham S, Bonacrum D. Qual Saf Health 13 (suppl 1):i85-i90, 2004.

The journal articles below require member access:

A Review of the 2008 NICHD Research Planning Workshop: Recommendations for Fetal Heart Rate Terminology and Interpretation HANKINS, GARY D.V.; MILLER, DAVID A. Clinical Obstetrics & Gynecology. 54(1):3-7, March 2011.

Assessment and Optimization of Uterine Activity During Labor
SIMPSON, KATHLEEN R.; MILLER, LISA. Clinical Obstetrics & Gynecology. 54(1):40-49, March 2011.

Clinical disagreements during labor and birth: how does real life compare to best practice?
Simpson KR, Lyndon A. MCN Am J Matern Child Nurs. 34(1):31-9, 2009.

Fetal ECG Analysis for Intrapartum Electronic Fetal Monitoring: A Review
DEVOE, LAWRENCE D. Clinical Obstetrics & Gynecology. 54(1):56-65, March 2011.

High Reliability Perinatal Units: An approach to the prevention of patient injury and medical malpractice claims.
Knox G, Simpson K, Garite T. J Healthcare Risk Manag 19(2):24-32, 1999.

Intrapartum Fetal Monitoring: Liability and Documentation
MILLER, LISA.  Clinical Obstetrics & Gynecology. 54(1):50-55, March 2011.

Intrauterine Resuscitation During Labor
GARITE, THOMAS J.; SIMPSON, KATHLEEN RICE. Clinical Obstetrics & Gynecology. 54(1):28-39, March 2011.

Labor and Fetal Heart Rate Decelerations: Relation to Fetal Metabolic Acidosis
ROSS, MICHAEL G. Clinical Obstetrics & Gynecology. 54(1):74-82, March 2011.

Multidisciplinary teamwork approach in labor and delivery and electronic fetal monitoring education: a medical-legal perspective. Collins DE . J Perinat Neonatal Nurs. 22(2):125-32, 2008.

Nurses' views of factors that help and hinder their intrapartum care.
Sleutel M, Schultz S, Wyble K. J Obstet Gynecol Neonatal Nurs 36:203-11, 2007.

Patient safety and teamwork in perinatal care.
Miller LA. J Perinat Neonatal Nurs 19(1):46-51, 2005.

Safety promotion and error reduction in perinatal care: Lessons from industry.
Miller LA, J Perinat Neonatal Nurs 17(2):128-138, 2003.

Standardization of Intrapartum Management and Impact on Adverse Outcomes
PETTKER, CHRISTIAN M. Clinical Obstetrics & Gynecology. 54(1):8-15, March 2011.

Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine. Roswarski TE, Murray MD. Med Decis Making. 26(2):154-61; 2006.



How Doctors Think
- Groopman, J;
Houghton Mifflin, Boston; 2007.


EFMHow We Know What Isn’t So: The Fallibility
of Human Reason in Everyday Life
Gilovich, T; The Free Press, New York; 1991.


EMFMistakes Were Made, But Not By Me
-Tavris, C; Aronson, E; Harcourt, Orlando; 2007


Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach (6th ed.) -Tucker, S.M., Miller, L.A., Miller, D.A.; Mosby, St. Louis, 2009.

EFMThe Psychology of Judgment and Decision
- Plous, S; McGraw-Hill, St. Louis; 1993.




AHRQAgency for Healthcare Research and Quality - Effective Healthcare Program: Helping you make better treatment choices. AHRQ is a division of the US Dept of Health and Human Services

AWHONNFHMAWHONN - Association of Women’s Health, Obstetric and Neonatal Nurses Promoting the Health of Women and Newborns

HANYSHealthcare Association of New York State (HANYS) - HANYS is an association that provides leadership, representation, and service to health providers and systems across the entire continuum of care.

NCCNational Certification Corporation (NCC)
NCC provides a national credentialing program for nurses, physicians and other licensed health care personnel.

DOHNew York State Department of Health
Information for a healthy New York. Includes links to the state’s electronic fetal monitoring data and patient safety topics.

Perinatal Quality FoundationPerinatal Quality Foundation: Fetal Monitoring Credentialing

PRMESPerinatal Risk Management and Education Services (PRMES)
"Risk reduction through education.” Includes links to Miller’s ReadRight EFM ruler and Miller’s ReadRight differential cards. EFM Logo






ACOG District II:
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American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998