EFM CERTIFICATION EXAM 3 FINAL PAPER
2026 QUESTIONS WITH FULL ANSWERS
◉ Late deceleration. Answer: transient hypoxemia is the physiologic
cause; during hypoxemia, fetus may convert to anaerobic
metabolism
◉ Variable deceleration. Answer: can be stimulated by abrupt rise in
fetal BP
◉ Fetal behavioral states. Answer: sleep cycles ~40 minutes; quiet
sleep (minimal variability, rare accels); active sleep (frequent
movements, minimal-mod variability, frequent accels); quiet awake
(mod variability, infrequent movement); active awake (continuous
movement, mod variability, frequent accels)
◉ Amniotic fluid. Answer: 30 ml at 10 weeks to 780 ml at 32-35
weeks; symmetric growth, shock absorption, maintained by fetal
fluid production and osmotic balance
◉ Polyhydramnios. Answer: single MVP > 8 cm or AFI >24; 1% of
pregnancies; 60% idiopathic; multiple gestation, maternal diabetes,
hydrops, anomalies, TORCH; ass'd with cardiac/GI issues/renal
issues
,◉ 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
◉ Baseline. Answer: founded to nearest 5 bpm, evaluated over 10
minutes; 2 non-continuous minutes needed to ascertain baseline;
excludes accels, decels, marked variability
◉ Normal baseline. Answer: 110-160
◉ Accelerations. Answer: abrupt increase of at least 15 bpm in FHR
above the baseline; onset to peak less than 30 seconds, =/>15
seconds, less than 2 minutes from onset to return to baseline
◉ Accelerations at >/. Answer: 32 weeks gestations = 15 beats x 15
seconds; 28-32 weeks 10 x 10; whether spontaneous or provoked,
they are predictive of adequate central fetal oxygenation and a pH of
at least 7.19; rule out acidemia at time they are observed
◉ Vibroacoustic/scalp stimulation. Answer: during sleep periods;
never attempt to stimulate a stressed baby
◉ Prolonged acceleration. Answer: 2-10 minutes
, ◉ Change in baseline. Answer: >10 minutes
◉ Early decelerations. Answer: usually symmetrical, graduate
decrease in FHR; >30 seconds from onset to nadir; nadir of
deceleration occurs at the same time as peak of the contraction
◉ Late decelerations. Answer: usually symmetrical, gradual
decrease in FHR; >/=30 seconds from onset to nadir; nadir of
deceleration after the peak of the contraction; subtle "depth" still
counts as late decelerations
◉ Variable decelerations. Answer: abrupt < 30 seconds deceleration
to the nadir. Decrease in FHR below the baseline =/> 15 bpm lasting
15 seconds or more, <2 minutes from onset to return to baseline;
can vary with morphology
◉ Prolonged decelerations. Answer: FHR decrease below baseline
by 15 bpm lasting 2-10 minutes; may be followed by
overcompensation/increased baseline; can be from tachysystole,
placental abruption, maternal hypotension, uterine rupture,
maternal hypoxia, cord accidents, terminal fetal conditions, rapid
fetal descent
2026 QUESTIONS WITH FULL ANSWERS
◉ Late deceleration. Answer: transient hypoxemia is the physiologic
cause; during hypoxemia, fetus may convert to anaerobic
metabolism
◉ Variable deceleration. Answer: can be stimulated by abrupt rise in
fetal BP
◉ Fetal behavioral states. Answer: sleep cycles ~40 minutes; quiet
sleep (minimal variability, rare accels); active sleep (frequent
movements, minimal-mod variability, frequent accels); quiet awake
(mod variability, infrequent movement); active awake (continuous
movement, mod variability, frequent accels)
◉ Amniotic fluid. Answer: 30 ml at 10 weeks to 780 ml at 32-35
weeks; symmetric growth, shock absorption, maintained by fetal
fluid production and osmotic balance
◉ Polyhydramnios. Answer: single MVP > 8 cm or AFI >24; 1% of
pregnancies; 60% idiopathic; multiple gestation, maternal diabetes,
hydrops, anomalies, TORCH; ass'd with cardiac/GI issues/renal
issues
,◉ 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
◉ Baseline. Answer: founded to nearest 5 bpm, evaluated over 10
minutes; 2 non-continuous minutes needed to ascertain baseline;
excludes accels, decels, marked variability
◉ Normal baseline. Answer: 110-160
◉ Accelerations. Answer: abrupt increase of at least 15 bpm in FHR
above the baseline; onset to peak less than 30 seconds, =/>15
seconds, less than 2 minutes from onset to return to baseline
◉ Accelerations at >/. Answer: 32 weeks gestations = 15 beats x 15
seconds; 28-32 weeks 10 x 10; whether spontaneous or provoked,
they are predictive of adequate central fetal oxygenation and a pH of
at least 7.19; rule out acidemia at time they are observed
◉ Vibroacoustic/scalp stimulation. Answer: during sleep periods;
never attempt to stimulate a stressed baby
◉ Prolonged acceleration. Answer: 2-10 minutes
, ◉ Change in baseline. Answer: >10 minutes
◉ Early decelerations. Answer: usually symmetrical, graduate
decrease in FHR; >30 seconds from onset to nadir; nadir of
deceleration occurs at the same time as peak of the contraction
◉ Late decelerations. Answer: usually symmetrical, gradual
decrease in FHR; >/=30 seconds from onset to nadir; nadir of
deceleration after the peak of the contraction; subtle "depth" still
counts as late decelerations
◉ Variable decelerations. Answer: abrupt < 30 seconds deceleration
to the nadir. Decrease in FHR below the baseline =/> 15 bpm lasting
15 seconds or more, <2 minutes from onset to return to baseline;
can vary with morphology
◉ Prolonged decelerations. Answer: FHR decrease below baseline
by 15 bpm lasting 2-10 minutes; may be followed by
overcompensation/increased baseline; can be from tachysystole,
placental abruption, maternal hypotension, uterine rupture,
maternal hypoxia, cord accidents, terminal fetal conditions, rapid
fetal descent
