CEFM EXAM REVIEW QUESTIONS
SOLUTIONS 2026 VERIFIED CORRECT
ANSWERS GRADED A+
⩥ what is an early deceleration?
Answer: during uterine contractions
visually apparent, gradual decrease and return of FHR associated with a
contraction (onset to nadir > 30 seconds)
occurs at the same time / mirrors a contraction
⩥ what does an early deceleration represent?
Answer: a reflex fetal response to fetal head compression from
cephalopelvic disproportion, fetal descent, or cervical exam
⩥ early decelerations are considered clinically...
Answer: benign
⩥ what is physiologic mechanism of early declerations?
Answer: transient fetal head compression → ↑ intracranial
pressure/alteration in cerebral blood flow → reflex parasympathetic
outflow/vagal stimulation → gradual slowing of the FHR → early
deceleration → when head compression is relieved, autonomic reflexes
subside
,⩥ what is a variable deceleration?
Answer: an abrupt decrease in fetal heart rate (onset to nadir < 30
seconds); decrease is > 15 bpm from baseline lasting > 15 seconds and <
2 minutes from onset to return to baseline
not necessarily associated with uterine contraction
⩥ what does a variable deceleration represent?
Answer: a reflex fetal response to interruption of the oxygen pathway at
one or more points
⩥ what is the physiologic mechanism of a variable deceleration?
Answer: umbilical cord compression → initial compression of umbilical
vein → transient decreased fetal venous return → transient reduction in
fetal cardiac output and blood pressure → baroreceptor stimulation →
transient reflex rise in FHR → umbilical artery compression → abrupt
rise in fetal peripheral resistance and blood pressure → baroreceptor
stimulation → reflex parasympathetic outflow → abrupt slowing of the
FHR → variable deceleration → when umbilical cord compression is
relieved, this process occurs in reverse
⩥ what is a late deceleration?
Answer: visually apparent, gradual decrease and return of the FHR
associated with a uterine contraction (onset to nadir > 30 seconds)
, delayed in timing with nadir of decel occurring after the peak of the
contraction
⩥ what does a late deceleration represent?
Answer: reflex fetal response to transient interruption of the oxygen
pathway at one or more points during a uterine contraction, resulting in
transient fetal hypoxemia
⩥ late decelerations result from...
Answer: uteroplacental insufficiency or compromised uteroplacental
perfusion
⩥ what is the physiologic mechanism of a late deceleration?
Answer: uterine contraction impedes maternal perfusion of the placental
intervillous space → transient fetal hypoxemia (low level of O2 in
blood) → chemoreceptor stimulation → reflex sympathetic outflow →
peripheral vasoconstriction, preferentially shunting oxygenated blood
away from the peripheral tissues and toward central vital organs: brain,
heart & adrenal glands → increase in fetal peripheral resistance and
blood pressure → baroreceptor stimulation → reflex parasympathetic
outflow → gradual slowing of the FHR → late deceleration → after the
contraction, these reflexes subside
⩥ in presence of fetal metabolic acidemia, transient hypoxemia (low
level of O2 in the blood)...
SOLUTIONS 2026 VERIFIED CORRECT
ANSWERS GRADED A+
⩥ what is an early deceleration?
Answer: during uterine contractions
visually apparent, gradual decrease and return of FHR associated with a
contraction (onset to nadir > 30 seconds)
occurs at the same time / mirrors a contraction
⩥ what does an early deceleration represent?
Answer: a reflex fetal response to fetal head compression from
cephalopelvic disproportion, fetal descent, or cervical exam
⩥ early decelerations are considered clinically...
Answer: benign
⩥ what is physiologic mechanism of early declerations?
Answer: transient fetal head compression → ↑ intracranial
pressure/alteration in cerebral blood flow → reflex parasympathetic
outflow/vagal stimulation → gradual slowing of the FHR → early
deceleration → when head compression is relieved, autonomic reflexes
subside
,⩥ what is a variable deceleration?
Answer: an abrupt decrease in fetal heart rate (onset to nadir < 30
seconds); decrease is > 15 bpm from baseline lasting > 15 seconds and <
2 minutes from onset to return to baseline
not necessarily associated with uterine contraction
⩥ what does a variable deceleration represent?
Answer: a reflex fetal response to interruption of the oxygen pathway at
one or more points
⩥ what is the physiologic mechanism of a variable deceleration?
Answer: umbilical cord compression → initial compression of umbilical
vein → transient decreased fetal venous return → transient reduction in
fetal cardiac output and blood pressure → baroreceptor stimulation →
transient reflex rise in FHR → umbilical artery compression → abrupt
rise in fetal peripheral resistance and blood pressure → baroreceptor
stimulation → reflex parasympathetic outflow → abrupt slowing of the
FHR → variable deceleration → when umbilical cord compression is
relieved, this process occurs in reverse
⩥ what is a late deceleration?
Answer: visually apparent, gradual decrease and return of the FHR
associated with a uterine contraction (onset to nadir > 30 seconds)
, delayed in timing with nadir of decel occurring after the peak of the
contraction
⩥ what does a late deceleration represent?
Answer: reflex fetal response to transient interruption of the oxygen
pathway at one or more points during a uterine contraction, resulting in
transient fetal hypoxemia
⩥ late decelerations result from...
Answer: uteroplacental insufficiency or compromised uteroplacental
perfusion
⩥ what is the physiologic mechanism of a late deceleration?
Answer: uterine contraction impedes maternal perfusion of the placental
intervillous space → transient fetal hypoxemia (low level of O2 in
blood) → chemoreceptor stimulation → reflex sympathetic outflow →
peripheral vasoconstriction, preferentially shunting oxygenated blood
away from the peripheral tissues and toward central vital organs: brain,
heart & adrenal glands → increase in fetal peripheral resistance and
blood pressure → baroreceptor stimulation → reflex parasympathetic
outflow → gradual slowing of the FHR → late deceleration → after the
contraction, these reflexes subside
⩥ in presence of fetal metabolic acidemia, transient hypoxemia (low
level of O2 in the blood)...
