NCC ELECTRONIC FETAL MONITORING
CERTIFICATION ACTUAL TEST PAPER
COMPLETE QUESTIONS AND ANSWERS
FULL SOLUTION
●● Oligohydramnios
Answer: single MVP < 2 cm or AFI < 5 at term (less than 5%ile);
associated with FGR, placental abnormalities, urinary tract
abnormalities, post-term pregnancies, ruptured or idiopathic membranes
●● Doppler
Answer: US transducer, depicts valve closure; uses autocorrelation
●● Autocorrelation
Answer: successive US waveforms at many points; current technology
which is more accurate at detecting FHR variability; controls artifact
sound waves
●● Toco/tocotransducer
Answer: detects change in contour with contractions; place at fundus or
at area of maximum palpation; difficult to measure with obesity,
polyhydramnios
,●● Fetal scalp electrode measures
Answer: R-R waves; still has issues with artifact; risk of injury,
measuring maternal HR in instance of fetal demise; rupture and dilation
required
●● IUPC
Answer: solid>fluid filled tips, measures mmHg and allows
amnioinfusion; issue with displacement, perforation, placental abruption
●● Intermittent auscultation
Answer: goal is baseline 110-160, +/-accels, no decels; if present, put on
continuous monitor min 20 minutes); cannot determine variability or
types of FHR decels
●● Active phase auscultation
Answer: q15 min for high risk up to q30min
●● Second stage auscultation
Answer: q5 min if high risk up to q15min
●● Fetal tolerance of labor
Answer: auscultate after a contraction x 30-60 seconds; document rate,
rhythm, accels, decels
,●● Doppler vs. fetoscope
Answer: doppler uses autocorrelation and detects valve closure;
fetoscope listens through opening in heart wall?
●● Signal ambiguity
Answer: confusing maternal and fetal heart rate; common with
repositioning, fetal movement, during pushing (maternal tachycardia);
can occur even with fetal demise due to FSE recording maternal blood
flow through the placenta
●● Suspect signal ambiguity
Answer: when there is lower baseline or >50% contractions with
accelerations (especially with pushing); verify and document maternal
heart rate via pulse oximetry
●● Halving/doubling
Answer: Halving occurs if FHR >180-200; may double if rate <50
●● Extrinsic factors
Answer: maternal oxygenation, uterine blood flow, placenta exchange,
umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of
tissues, FHR regulation
●● Primary source of oxygen for the feus
, Answer: the maternal respiratory system
●● Uterine blood flow
Answer: 60ml/min non-pregnant vs. 500-1000ml/min; 10-15% maternal
cardiac output
●● Normal blood flow pathway
Answer: Blood from maternal vein > intervillous pool of maternal blood
> umbilical vein (oxygenated blood)
●● Normal placenta
Answer: Placenta has 15-20 lobules on maternal surface; Decreased
surface area of chorionic villi from abnormal development, infection,
thrombosis, hemorrhage, inflammation (chorio increases risk of CP),
degenerative changes with increasing gestational age
(calcifications)/HTN/DM - can cause IUGR, hypoxia, FHR decels
●● Acute drop in placental function
Answer: fetal asphyxia
●● Chronic drop in placental function
Answer: FGR
●● O2 and CO2
CERTIFICATION ACTUAL TEST PAPER
COMPLETE QUESTIONS AND ANSWERS
FULL SOLUTION
●● Oligohydramnios
Answer: single MVP < 2 cm or AFI < 5 at term (less than 5%ile);
associated with FGR, placental abnormalities, urinary tract
abnormalities, post-term pregnancies, ruptured or idiopathic membranes
●● Doppler
Answer: US transducer, depicts valve closure; uses autocorrelation
●● Autocorrelation
Answer: successive US waveforms at many points; current technology
which is more accurate at detecting FHR variability; controls artifact
sound waves
●● Toco/tocotransducer
Answer: detects change in contour with contractions; place at fundus or
at area of maximum palpation; difficult to measure with obesity,
polyhydramnios
,●● Fetal scalp electrode measures
Answer: R-R waves; still has issues with artifact; risk of injury,
measuring maternal HR in instance of fetal demise; rupture and dilation
required
●● IUPC
Answer: solid>fluid filled tips, measures mmHg and allows
amnioinfusion; issue with displacement, perforation, placental abruption
●● Intermittent auscultation
Answer: goal is baseline 110-160, +/-accels, no decels; if present, put on
continuous monitor min 20 minutes); cannot determine variability or
types of FHR decels
●● Active phase auscultation
Answer: q15 min for high risk up to q30min
●● Second stage auscultation
Answer: q5 min if high risk up to q15min
●● Fetal tolerance of labor
Answer: auscultate after a contraction x 30-60 seconds; document rate,
rhythm, accels, decels
,●● Doppler vs. fetoscope
Answer: doppler uses autocorrelation and detects valve closure;
fetoscope listens through opening in heart wall?
●● Signal ambiguity
Answer: confusing maternal and fetal heart rate; common with
repositioning, fetal movement, during pushing (maternal tachycardia);
can occur even with fetal demise due to FSE recording maternal blood
flow through the placenta
●● Suspect signal ambiguity
Answer: when there is lower baseline or >50% contractions with
accelerations (especially with pushing); verify and document maternal
heart rate via pulse oximetry
●● Halving/doubling
Answer: Halving occurs if FHR >180-200; may double if rate <50
●● Extrinsic factors
Answer: maternal oxygenation, uterine blood flow, placenta exchange,
umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of
tissues, FHR regulation
●● Primary source of oxygen for the feus
, Answer: the maternal respiratory system
●● Uterine blood flow
Answer: 60ml/min non-pregnant vs. 500-1000ml/min; 10-15% maternal
cardiac output
●● Normal blood flow pathway
Answer: Blood from maternal vein > intervillous pool of maternal blood
> umbilical vein (oxygenated blood)
●● Normal placenta
Answer: Placenta has 15-20 lobules on maternal surface; Decreased
surface area of chorionic villi from abnormal development, infection,
thrombosis, hemorrhage, inflammation (chorio increases risk of CP),
degenerative changes with increasing gestational age
(calcifications)/HTN/DM - can cause IUGR, hypoxia, FHR decels
●● Acute drop in placental function
Answer: fetal asphyxia
●● Chronic drop in placental function
Answer: FGR
●● O2 and CO2
