NCC EFM COMPREHENSIVE EXAM SCRIPT
VERIFIED QUESTIONS COMPLETE
ANSWERS GRADED APLUS
◉ Arrest of labor
Answer: >6cm dilated w/ ROM & one of the following w no cx
change:
-4 hrs of adequate contractions (>200 MVUs)
-6 hrs of inadequate contractions
◉ Fetal dysrhythmias
Answer: 1) SVT: 210-300 bpm
-tx w digoxin (↑ dose to cross placenta)
-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓ stroke
volume, demise
2) Congenital heart block (<60 bpm): 3rd degree → concern w
hydrops, lupus, CHF
3) Ectopic beats: extra beats heard, benign, may be transient
◉ Lupus (SLE)
Answer: Can cause congenital 3rd degree heart block
-bradycardia
,-autoimmune → inflammatory response → overgrowth of collagen in
heart muscle
-damages fetal conduction system of the heart, attacks fetal tissue
-usually diagnosed in 2nd trimester
◉ Preterm labor
Answer: Cx dilation bw 20-36.6 wks
-late preterm: 34-36.6 wks
-common risk factors: multiples, previous PTD (greatest), uterine or
cx abnormalities, infection, <18 months bw pregnancies, IUGR
-↓ reserve & ↓ parasympathetic maturity
-↑ baseline, ↓ variability, ↑ variable decels
◉ Treatment for preterm labor
Answer: 1) Steroids (BMZ, DMZ): allows for synthesis of surfactant &
↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round
after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give
steroids
-SE: hyperglycemia, hypotension, tachycardia
, -Not given w ↑HR, bleeding, uncontrolled diabetes
3) Nifedipine / procardia (Ca channel blocker): ↓ contractility of
smooth muscles, vasodilates
4) Indocin (NSAID, prostaglandin inhibitor): tocolytic
-AE: oligo, GI upset, renal failture, PP hemorrhage
5) Mag: neuroprotection, vasodilates ↑ blood flow to brain, ↓ risk of
CP
-can cause fetal bradycardia & ↓ variability
◉ Postdates pregnancy
Answer: >42 wks
-risk of oligo, ↓ placental perfusion, & meconium aspiration
-newborn appearance: peeling dry wrinkled skin, long nails, thinner
(weight loss)
-↑ rate of c/s, recommended to induce at 41 wks
-↑ late decels (old placenta) & variables (oligo)
◉ Hypertension (HTN)
Answer: BP > 140/90
-tx w Ca channel blockers, thiazides, BB
-avoid ACE inhibitors & ARBs (congenital defect)
1) Chronic: present prior to pregnancy
VERIFIED QUESTIONS COMPLETE
ANSWERS GRADED APLUS
◉ Arrest of labor
Answer: >6cm dilated w/ ROM & one of the following w no cx
change:
-4 hrs of adequate contractions (>200 MVUs)
-6 hrs of inadequate contractions
◉ Fetal dysrhythmias
Answer: 1) SVT: 210-300 bpm
-tx w digoxin (↑ dose to cross placenta)
-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓ stroke
volume, demise
2) Congenital heart block (<60 bpm): 3rd degree → concern w
hydrops, lupus, CHF
3) Ectopic beats: extra beats heard, benign, may be transient
◉ Lupus (SLE)
Answer: Can cause congenital 3rd degree heart block
-bradycardia
,-autoimmune → inflammatory response → overgrowth of collagen in
heart muscle
-damages fetal conduction system of the heart, attacks fetal tissue
-usually diagnosed in 2nd trimester
◉ Preterm labor
Answer: Cx dilation bw 20-36.6 wks
-late preterm: 34-36.6 wks
-common risk factors: multiples, previous PTD (greatest), uterine or
cx abnormalities, infection, <18 months bw pregnancies, IUGR
-↓ reserve & ↓ parasympathetic maturity
-↑ baseline, ↓ variability, ↑ variable decels
◉ Treatment for preterm labor
Answer: 1) Steroids (BMZ, DMZ): allows for synthesis of surfactant &
↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round
after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give
steroids
-SE: hyperglycemia, hypotension, tachycardia
, -Not given w ↑HR, bleeding, uncontrolled diabetes
3) Nifedipine / procardia (Ca channel blocker): ↓ contractility of
smooth muscles, vasodilates
4) Indocin (NSAID, prostaglandin inhibitor): tocolytic
-AE: oligo, GI upset, renal failture, PP hemorrhage
5) Mag: neuroprotection, vasodilates ↑ blood flow to brain, ↓ risk of
CP
-can cause fetal bradycardia & ↓ variability
◉ Postdates pregnancy
Answer: >42 wks
-risk of oligo, ↓ placental perfusion, & meconium aspiration
-newborn appearance: peeling dry wrinkled skin, long nails, thinner
(weight loss)
-↑ rate of c/s, recommended to induce at 41 wks
-↑ late decels (old placenta) & variables (oligo)
◉ Hypertension (HTN)
Answer: BP > 140/90
-tx w Ca channel blockers, thiazides, BB
-avoid ACE inhibitors & ARBs (congenital defect)
1) Chronic: present prior to pregnancy
