NCC EFM Exam Breakdown &
Study Guide QUESTIONS
WITH ANSWERS .
Arrest of labor - CORRECT 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
Artifact - CORRECT ANSWER✅✅Interference in recording or transmission, seen as
vertical lines along tracing
-Causes: vaginal exam, fetal movement, connection issue, hair or caput w ISE
-R/o arrhythmia (can see & hear skips, has baseline, isolated spikes), try another
method of monitoring, verify w fetoscope
Auscultation - CORRECT ANSWER✅✅Intermittently listening to fetal heart sounds w
fetoscope or doppler to assess FHR
-Detects baseline, rhythm, increases & decreases from baseline
-Cannot determine variability or classify decels
-Use of fetoscope can verify presence of arrhythmia (most accurate) & clarifies halving
or doubling
-Listen to FHR before, during, & for 30 sec after contraction
-Feel for mom's radial pulse to differentiate
Biophysical Profile (BPP) - CORRECT ANSWER✅✅Normal = 2 points, abnormal = 0
-Can be done ≥28 wks, valid for 7 days
-BPP done over 30 mins
1) Fetal heart rate
2) Breathing movements
3) Gross body movements
4) Muscle tone: extension/flexion
5) Amniotic fluid volume: (>2cm or AFI >5)
Category I tracing - CORRECT ANSWER✅✅Normal acid base balance
-Baseline between 110 to 160
-Moderate variability
-No late, variable, or prolonged decels
-May have early decels
-May or may not have accels
, Category II tracing - CORRECT ANSWER✅✅Indeterminate acid base balance
-Minimal variability
-Marked variability
-Late or variable decels
-Bradycardia with variability
-Tachycardia
-Prolonged decels
-Absent variability w NO decels
-Absence of induced acccel WITH fetal stimulation
Category III tracing - CORRECT ANSWER✅✅Predictive of abnormal acid base
balance at that moment
-Sinusoidal rhythm: has to last ≥20min, r/t anemia (previa, bleeding, abruption)
-Absent variability WITH one of the following: bradycardia, recurrent late or recurrent
variable decels
-Decide for c/s within 30min
Content on exam - CORRECT ANSWER✅✅-Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Cord blood & acid base balance - CORRECT ANSWER✅✅Direct measurement of
oxygenation (at the time of delivery)
-Base deficit or base excess of +/-12 & a pH <7.1 = high probability of neonatal
encephalopathy r/t intrapartum
-Umbilical artery value is more predictive
-Respiratory acidosis: ↑ CO2 >60, normal BD/BE, normal bicarb, can develop quickly &
be resolved easily
-Metabolic acidosis: normal CO2, ↓ bicarb <22, abnormal BD/BE, r/t anaerobic
metabolism (lactic acid build up), difficult to resolve
-CAN have both metabolic & respiratory (↑ CO2, ↓ bicarb, abnormal BD/BE)
Diabetes - CORRECT ANSWER✅✅-Excess glucose delays surfactant production
(RDS)
-T1 & T2 more likely to cause congenital abnormalities (heart & neural tube defect)
-Hypoglycemia at birth: glucose crosses placenta but not insulin, fetus has ↑ insulin
production & bottoms out after delivery
-Risk of LGA, fetal acidosis, impaired perfusion, polycythemia, demise, UTI,
polyhydramnios, abruption, PPH, Pre-E (r/t vascular damage), miscarriage
-Induce at 38-39 wks
Early deceleration - CORRECT ANSWER✅✅Nadir aligns w contraction peak, gradual
onset (≥30 secs to nadir), benign vagal response
1) Pressure on fetal head
Study Guide QUESTIONS
WITH ANSWERS .
Arrest of labor - CORRECT 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
Artifact - CORRECT ANSWER✅✅Interference in recording or transmission, seen as
vertical lines along tracing
-Causes: vaginal exam, fetal movement, connection issue, hair or caput w ISE
-R/o arrhythmia (can see & hear skips, has baseline, isolated spikes), try another
method of monitoring, verify w fetoscope
Auscultation - CORRECT ANSWER✅✅Intermittently listening to fetal heart sounds w
fetoscope or doppler to assess FHR
-Detects baseline, rhythm, increases & decreases from baseline
-Cannot determine variability or classify decels
-Use of fetoscope can verify presence of arrhythmia (most accurate) & clarifies halving
or doubling
-Listen to FHR before, during, & for 30 sec after contraction
-Feel for mom's radial pulse to differentiate
Biophysical Profile (BPP) - CORRECT ANSWER✅✅Normal = 2 points, abnormal = 0
-Can be done ≥28 wks, valid for 7 days
-BPP done over 30 mins
1) Fetal heart rate
2) Breathing movements
3) Gross body movements
4) Muscle tone: extension/flexion
5) Amniotic fluid volume: (>2cm or AFI >5)
Category I tracing - CORRECT ANSWER✅✅Normal acid base balance
-Baseline between 110 to 160
-Moderate variability
-No late, variable, or prolonged decels
-May have early decels
-May or may not have accels
, Category II tracing - CORRECT ANSWER✅✅Indeterminate acid base balance
-Minimal variability
-Marked variability
-Late or variable decels
-Bradycardia with variability
-Tachycardia
-Prolonged decels
-Absent variability w NO decels
-Absence of induced acccel WITH fetal stimulation
Category III tracing - CORRECT ANSWER✅✅Predictive of abnormal acid base
balance at that moment
-Sinusoidal rhythm: has to last ≥20min, r/t anemia (previa, bleeding, abruption)
-Absent variability WITH one of the following: bradycardia, recurrent late or recurrent
variable decels
-Decide for c/s within 30min
Content on exam - CORRECT ANSWER✅✅-Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Cord blood & acid base balance - CORRECT ANSWER✅✅Direct measurement of
oxygenation (at the time of delivery)
-Base deficit or base excess of +/-12 & a pH <7.1 = high probability of neonatal
encephalopathy r/t intrapartum
-Umbilical artery value is more predictive
-Respiratory acidosis: ↑ CO2 >60, normal BD/BE, normal bicarb, can develop quickly &
be resolved easily
-Metabolic acidosis: normal CO2, ↓ bicarb <22, abnormal BD/BE, r/t anaerobic
metabolism (lactic acid build up), difficult to resolve
-CAN have both metabolic & respiratory (↑ CO2, ↓ bicarb, abnormal BD/BE)
Diabetes - CORRECT ANSWER✅✅-Excess glucose delays surfactant production
(RDS)
-T1 & T2 more likely to cause congenital abnormalities (heart & neural tube defect)
-Hypoglycemia at birth: glucose crosses placenta but not insulin, fetus has ↑ insulin
production & bottoms out after delivery
-Risk of LGA, fetal acidosis, impaired perfusion, polycythemia, demise, UTI,
polyhydramnios, abruption, PPH, Pre-E (r/t vascular damage), miscarriage
-Induce at 38-39 wks
Early deceleration - CORRECT ANSWER✅✅Nadir aligns w contraction peak, gradual
onset (≥30 secs to nadir), benign vagal response
1) Pressure on fetal head
