CEFM EXAM /CEFM PRACTICE EXAM 2025
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS |ALREADY GRADED A+|NEWEST
|GUARANTEED PASS|LATEST UPDATE
Why is it so important to get weight off the inferior vena cava?
allows more volume coming to the heart, thus perfusion of uterus, then placenta, then fetus.
Get pts off their backs.
If recurrent lates with moderate variability=
Less worrisome
If recurrent lates with minimal or absent variability- concerning for?
fetal acidemia/expedite delivery
Assess time for delivery is it a ways off or possibly within 30 minutes
If fetal tachycardia is isolated with moderate variability it's usually what? What about minimal
or absent variability?
benign finding and poor predictor of fetal acidemia
where as if accompanied by minimal or absent variability= possible fetal acidemia
What are possible causes of Bradycardia/prolonged decels?
hypotension, umbilical cord prolapse, rapid fetal descent, abruption, uterine rupture,
tachysystole
How much reserve does a fetus have? When does baby start showing signs of lack of O2?
1|Page
,A fetus generally has about 1 hr of reserve once the perfusion/oxygenation gets challenged
(about an hour to recognize and act with interventions). Baby starts showing signs of concerns
for lack of oxygenation when there's about a 50% depletion of O2.
What diagnosed causes of fetal bradycardia?
Note if bradycardia from a heart block/collagen vascular disease- 2nd trimester presentation at
diagnosis, not intrapartum
What disorders can cause fetal heart block leading to bradycardia?
Lupus, Sjogren's, RA
Anti- SSA or SSB antibodies block the AV node
What is the significance of 1st degree heart block?
2nd?
3rd?
Degrees of blocks 1st deg> Undetectable on EFM
2nd deg> missed beats/spikes
3rd deg> Bradycardia (think structural issue/hydrops)
What are maternal risk factors and fetal reserve challengers?
HTN, Diabetes, Oligohydramnios, Placental Function, IUGR
Always keep in context expected delivery with cat 2 strips:
Time, stage, and phase of labor. Dilating 1cm/hr is there anticipation that this will be another 6+
hours until delivery or within the next 10 mins?
What is considered a significant variable?
Variables dropping 60+bpm from the baseline lasting 60+seconds or that drop to 60 bpm
60 from baseline because if baseline was 150 and drops down to 85 and think it isn't too low
but that's still dropping about 65 Beats even if that drop is super low, whereas if baseline is 120
and drop is to 55 it's still the same drop
What is the most predictive for fetal acidosis and the need for urgent delivery? Why?
Minimal variability during the hour preceding fetal bradycardia. Minimal is potential indication
for fetal acidosis
How can minimal variability develop?
2|Page
,The lack of O2 can affect autonomic nervous system so there's not as much competition
because there's not as much O2 between sympathetic and parasympathetic where they
competing and doing that up down, up down, they get tired and don't have as much O2 so
there's not as much competition so there's not as much variability and this is where minimal
variability can start to exist.
What are the 3 S's of minimal variability?
Sleep (20-60 minutes), sick, sedation
Most common reason for minimal variability is?
Fetal sleep
If it's possible baby is just sleeping go turn pt since it's least invasive. This is a "wellness check"
to see if baby is sleeping well can expect accels if we've disturbed them by turning pt.
What can cause sedation leading to minimal variability?
Sedation from drugs such as opioids (1-2 hours) or magnesium
What interventions can treat sick? If these interventions are not effective what else can be
done?
acidosis risk)- position change, IVF, O2 if no return to moderate variability= digital scalp
stimulation or vibroacoustic stim (indirect measures)
- If unresolved with these measures=
potentially fetal acidemia
What medications can potentially explain the minimal variability?
Think about if anything may have been given to cause this like stadol or mag. If it's none of
these there is potential risk for acidosis.
What is the significance of preterms and minimal variability?
Remember preterms don't typically achieve moderate variability so not as concerning.
What role does scalp stim have?
Scalp stim illicits startle reflex in baby so there will be a resultant acceleration or even return to
moderate variability so we know we woke baby up. This is a wellness check
A category III tracing is abnormal and is a risk for fetal ____________, neonatal
_________________, _______, and neonatal ______________
3|Page
, Acidemia; encephalopathy; CP; acidosis
A category III tracing is an OVERALL POOR PREDICTOR OF?
ABNORMAL NEUROLOGIC OUTCOME
What actions should be done with a category III tracing?
INTRAUTERINE RESUSCITATIVE MEASURES /PROMPT DELIVERY PLANS-
OR Team/Foley, IV, neonatal resuscitation team, assisted operative vaginal delivery, notifying
anesthesia
DECISION TO INCISION TIME OF? What is significant about this?
30 minutes
(however, if HIE injury prior to Category III, 30 minutes plus does not improve outcomes)
What is the optimal timeframe for delivery with a category III tracing?
OPTIMAL TIME FRAME FOR TO DELIVERY A CATEGORY III TRACING HAS NOT BEEN
ESTABLISHED****
However goal is to have baby out ASAP because not all babies have 30 minutes just because
baby is out in 30 minutes does not guarantee a good outcome.
The false-positive rate of EFM for predicting cerebral palsy is? When do most insults occur?
high, at greater than 99%> not
reliable (most insults are antepartum in timing)
EFM >>>> can have an increased rate of __________ and __________ ______________
______________ delivery and ________________ delivery for abnormal ______ patterns or
_________ or both-> rush to ___
Vacuum;forceps
Operative vaginal cesarean
FHR;acidosis; OR (and then baby may come out with 9,10 APGARs)
When the FHR tracing includes recurrent variable decelerations what should be considered?
amnioinfusion to relieve umbilical cord compression should be considered>>>FLOAT THE
CORD>>> Keep you out of OR
What has not been demonstrated to be a clinically useful test in evaluating fetal status>> Not
done in US?
Fetal pulse oximetry on fetal head
4|Page
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS |ALREADY GRADED A+|NEWEST
|GUARANTEED PASS|LATEST UPDATE
Why is it so important to get weight off the inferior vena cava?
allows more volume coming to the heart, thus perfusion of uterus, then placenta, then fetus.
Get pts off their backs.
If recurrent lates with moderate variability=
Less worrisome
If recurrent lates with minimal or absent variability- concerning for?
fetal acidemia/expedite delivery
Assess time for delivery is it a ways off or possibly within 30 minutes
If fetal tachycardia is isolated with moderate variability it's usually what? What about minimal
or absent variability?
benign finding and poor predictor of fetal acidemia
where as if accompanied by minimal or absent variability= possible fetal acidemia
What are possible causes of Bradycardia/prolonged decels?
hypotension, umbilical cord prolapse, rapid fetal descent, abruption, uterine rupture,
tachysystole
How much reserve does a fetus have? When does baby start showing signs of lack of O2?
1|Page
,A fetus generally has about 1 hr of reserve once the perfusion/oxygenation gets challenged
(about an hour to recognize and act with interventions). Baby starts showing signs of concerns
for lack of oxygenation when there's about a 50% depletion of O2.
What diagnosed causes of fetal bradycardia?
Note if bradycardia from a heart block/collagen vascular disease- 2nd trimester presentation at
diagnosis, not intrapartum
What disorders can cause fetal heart block leading to bradycardia?
Lupus, Sjogren's, RA
Anti- SSA or SSB antibodies block the AV node
What is the significance of 1st degree heart block?
2nd?
3rd?
Degrees of blocks 1st deg> Undetectable on EFM
2nd deg> missed beats/spikes
3rd deg> Bradycardia (think structural issue/hydrops)
What are maternal risk factors and fetal reserve challengers?
HTN, Diabetes, Oligohydramnios, Placental Function, IUGR
Always keep in context expected delivery with cat 2 strips:
Time, stage, and phase of labor. Dilating 1cm/hr is there anticipation that this will be another 6+
hours until delivery or within the next 10 mins?
What is considered a significant variable?
Variables dropping 60+bpm from the baseline lasting 60+seconds or that drop to 60 bpm
60 from baseline because if baseline was 150 and drops down to 85 and think it isn't too low
but that's still dropping about 65 Beats even if that drop is super low, whereas if baseline is 120
and drop is to 55 it's still the same drop
What is the most predictive for fetal acidosis and the need for urgent delivery? Why?
Minimal variability during the hour preceding fetal bradycardia. Minimal is potential indication
for fetal acidosis
How can minimal variability develop?
2|Page
,The lack of O2 can affect autonomic nervous system so there's not as much competition
because there's not as much O2 between sympathetic and parasympathetic where they
competing and doing that up down, up down, they get tired and don't have as much O2 so
there's not as much competition so there's not as much variability and this is where minimal
variability can start to exist.
What are the 3 S's of minimal variability?
Sleep (20-60 minutes), sick, sedation
Most common reason for minimal variability is?
Fetal sleep
If it's possible baby is just sleeping go turn pt since it's least invasive. This is a "wellness check"
to see if baby is sleeping well can expect accels if we've disturbed them by turning pt.
What can cause sedation leading to minimal variability?
Sedation from drugs such as opioids (1-2 hours) or magnesium
What interventions can treat sick? If these interventions are not effective what else can be
done?
acidosis risk)- position change, IVF, O2 if no return to moderate variability= digital scalp
stimulation or vibroacoustic stim (indirect measures)
- If unresolved with these measures=
potentially fetal acidemia
What medications can potentially explain the minimal variability?
Think about if anything may have been given to cause this like stadol or mag. If it's none of
these there is potential risk for acidosis.
What is the significance of preterms and minimal variability?
Remember preterms don't typically achieve moderate variability so not as concerning.
What role does scalp stim have?
Scalp stim illicits startle reflex in baby so there will be a resultant acceleration or even return to
moderate variability so we know we woke baby up. This is a wellness check
A category III tracing is abnormal and is a risk for fetal ____________, neonatal
_________________, _______, and neonatal ______________
3|Page
, Acidemia; encephalopathy; CP; acidosis
A category III tracing is an OVERALL POOR PREDICTOR OF?
ABNORMAL NEUROLOGIC OUTCOME
What actions should be done with a category III tracing?
INTRAUTERINE RESUSCITATIVE MEASURES /PROMPT DELIVERY PLANS-
OR Team/Foley, IV, neonatal resuscitation team, assisted operative vaginal delivery, notifying
anesthesia
DECISION TO INCISION TIME OF? What is significant about this?
30 minutes
(however, if HIE injury prior to Category III, 30 minutes plus does not improve outcomes)
What is the optimal timeframe for delivery with a category III tracing?
OPTIMAL TIME FRAME FOR TO DELIVERY A CATEGORY III TRACING HAS NOT BEEN
ESTABLISHED****
However goal is to have baby out ASAP because not all babies have 30 minutes just because
baby is out in 30 minutes does not guarantee a good outcome.
The false-positive rate of EFM for predicting cerebral palsy is? When do most insults occur?
high, at greater than 99%> not
reliable (most insults are antepartum in timing)
EFM >>>> can have an increased rate of __________ and __________ ______________
______________ delivery and ________________ delivery for abnormal ______ patterns or
_________ or both-> rush to ___
Vacuum;forceps
Operative vaginal cesarean
FHR;acidosis; OR (and then baby may come out with 9,10 APGARs)
When the FHR tracing includes recurrent variable decelerations what should be considered?
amnioinfusion to relieve umbilical cord compression should be considered>>>FLOAT THE
CORD>>> Keep you out of OR
What has not been demonstrated to be a clinically useful test in evaluating fetal status>> Not
done in US?
Fetal pulse oximetry on fetal head
4|Page
