EFD EXAM 2 PRACTICE EVALUATION 2026
QUESTION BANK FULL SOLUTION SET
◉ Variable deceleration.
Answer: Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping ≥15 bpm
lasting 15 secs to <2min
-Transient rise in PCO2 & fall in PO2
◉ Mechanisms of variable decelerations.
Answer: Abruptness r/t pressure changes
1) Vein obstruction → reflex tachy
-↓ venous return & cardiac output → hypotens → baroreceptor reflex
↑ in FHR to maintain BP
2) Arterial obstruction → decreased FHR
-obstructed blood flow back to placenta → HTN → baroreceptor
reflex of slowing FHR to maintain BP
◉ Late decelerations.
Answer: Uteroplacental insufficiency
-Indicative of transient fetal hypoxemia
,-Gradual onset: ≥30 secs to nadir w nadir occurring after peak of
contraction
-Priority is to maximize uteroplacental blood flow: position lateral
(off vena cava & aorta), fluid bolus (perfusion), O2, avoid
tachysystole
◉ Mechanisms of a late deceleration.
Answer: Low O2 → chemoreceptor response peripheral
vasoconstriction → blood flow to vital organs → HTN →
baroreceptor vagal stimulation → FHR decel
1) Decreased uteroplacental oxygenation (transient hypoxemia)
2) Chemoreceptor stimulation
3) Alpha adrenergic response (catecholamines, peripheral
vasoconstriction)
4) Fetal HTN
5) Baroreceptor stimulation
6) Parasympathetic response
7) FHR deceleration
8) ↓ myocardial stress
◉ Prolonged deceleration.
Answer: Decrease of ≥15 bpm lasting 2 to 9 mins (≥10 = change of
baseline)
-Vagal stimulation
, -Causes: hypotension, maternal hypoxia, cord prolapse, rapid decent,
profound cord compression, uterine rupture
◉ Sinusoidal pattern.
Answer: Visually apparent, smooth, sine wave-like pattern in FHR
lasting ≥20 minutes
-oscillation frequency: 3-5 cycles/min
-no variability classification or reactivity
-r/t severe anemia: previa, hemorrhage, abruption, RH
isoimmunization, asphyxia, infection, cardiac anomaly, twin to twin
transfusion, gastroschesis
-Transient if <20min, can be r/t thumb sucking or opioids (stadol,
fentanyl)
◉ Interventions.
Answer: -Position change: off of vena cava & aorta, least invasive, 1st
line of treatment
-Fluid bolus
-Amnioinfusion (for variables)
-Tocolytics (terb)
-Ephedrine to ↑ BP
-Supplemental O2: not used w O2 >95%, can cause vasoconstriction,
free radical formation, ocular toxicity if used limit to 15-30min
QUESTION BANK FULL SOLUTION SET
◉ Variable deceleration.
Answer: Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping ≥15 bpm
lasting 15 secs to <2min
-Transient rise in PCO2 & fall in PO2
◉ Mechanisms of variable decelerations.
Answer: Abruptness r/t pressure changes
1) Vein obstruction → reflex tachy
-↓ venous return & cardiac output → hypotens → baroreceptor reflex
↑ in FHR to maintain BP
2) Arterial obstruction → decreased FHR
-obstructed blood flow back to placenta → HTN → baroreceptor
reflex of slowing FHR to maintain BP
◉ Late decelerations.
Answer: Uteroplacental insufficiency
-Indicative of transient fetal hypoxemia
,-Gradual onset: ≥30 secs to nadir w nadir occurring after peak of
contraction
-Priority is to maximize uteroplacental blood flow: position lateral
(off vena cava & aorta), fluid bolus (perfusion), O2, avoid
tachysystole
◉ Mechanisms of a late deceleration.
Answer: Low O2 → chemoreceptor response peripheral
vasoconstriction → blood flow to vital organs → HTN →
baroreceptor vagal stimulation → FHR decel
1) Decreased uteroplacental oxygenation (transient hypoxemia)
2) Chemoreceptor stimulation
3) Alpha adrenergic response (catecholamines, peripheral
vasoconstriction)
4) Fetal HTN
5) Baroreceptor stimulation
6) Parasympathetic response
7) FHR deceleration
8) ↓ myocardial stress
◉ Prolonged deceleration.
Answer: Decrease of ≥15 bpm lasting 2 to 9 mins (≥10 = change of
baseline)
-Vagal stimulation
, -Causes: hypotension, maternal hypoxia, cord prolapse, rapid decent,
profound cord compression, uterine rupture
◉ Sinusoidal pattern.
Answer: Visually apparent, smooth, sine wave-like pattern in FHR
lasting ≥20 minutes
-oscillation frequency: 3-5 cycles/min
-no variability classification or reactivity
-r/t severe anemia: previa, hemorrhage, abruption, RH
isoimmunization, asphyxia, infection, cardiac anomaly, twin to twin
transfusion, gastroschesis
-Transient if <20min, can be r/t thumb sucking or opioids (stadol,
fentanyl)
◉ Interventions.
Answer: -Position change: off of vena cava & aorta, least invasive, 1st
line of treatment
-Fluid bolus
-Amnioinfusion (for variables)
-Tocolytics (terb)
-Ephedrine to ↑ BP
-Supplemental O2: not used w O2 >95%, can cause vasoconstriction,
free radical formation, ocular toxicity if used limit to 15-30min
