CEFM Exam Questions and Verified Answers Graded A+ 2026/27
Describe Fetal Heart Rate Monitoring - EFM may be external, internal or a combination
In the US, the majority of women have EFM during some or all of their labors
Each modality has both pros and cons
Describe Doppler Ultrasound - The doppler US transducer is used to assess FHR
characteristics and patterns. The transducer translates sound wave reflections into waveforms
which are interpreted by a computer and then exported as an audible sound and a waveform
pattern.
Problems: FHR artifact, doubling, halving, and detection of maternal heart rate
Current ultrasound FHR signal processing uses autocorrelation techniques and interpretation of
EFM data is based on this assumption
Describe internal fetal electrode - The FSE directly measures the FHR by measuring R to
R waves in successive QRS complexes. To place an FSE, adequate cervical dilation (usually at
least 2 cm) and ROM are needed.
Contraindications: placenta previa, hemophilia, maternal HIV, herpes infections, or when
presenting part is not identifiable
Problems: artifact, slight risk of fetal infection/injury, doubling or halving of the FHR, and pick
up of the MHR with fetal demise
,Other relative contraindications: syphilis, gonorrhea (not recommended but may be placed if a
clear benefit to a mother and fetus can be demonstrated by its use)
Describe external uterine monitoring - The tocotransducer (TOCO) is a pressure sensitive
button-like device that detects changes in the abdominal contour when there is a uterine
contraction. The specific location is determined by abdominal palpation and is ideally a smooth
part of the uterus where no fetal small parts are felt. Usually this is the fundus or whatever
uterine contractions are most easily palpated
The TOCO can best provide: relative strength, approximate duration, and approximate frequency
of contractions but cannot determine actual intensity. PALPATION IS ESSENTIAL
Problems: include its inherent limitations, possibility of inverted contractions and issues with
obesity
Describe internal uterine monitoring - IUPC allows for greater quantitative measurement
of uterine contraction frequency, duration, and intensity or peak intrauterine pressure and resting
tone
Three types: fluid-filled (other countries), transducer-tipped, and air-coupled or sensor-tipped
(what we used)
Measures: actual pressures in mmHg and most allow for amnioinfustion
,Indications for use: Need for amnioinfusion, titration of oxytocin for induction or augmentation
when external methods are not providing enough information, and lack of progress in labor
Problems: user error, displacement, placental abruption/shearing, and a small risk of uterine
perforation
What are the three types of IUPC monitors? - Fluid-filled: also called the water column
method, was the 1st type of IUPC available and use dramatically decreased after introduction of
the transducer-tipped catheter. It works by transmitting the pressure generated by a contraction
through a water column to a transducer located away from the source of pressure, typically at the
monitor site. This displaced fluid exerts pressure against a diaphragm in the transducer,
generating changes in the electrical resistance of a series of wires. These electrical changes are
converted to measures of pressure.
Transducer-tipped: Introduced in the 1980s as an alternative to fluid-filled. The force exerted by
a uterine contraction is converted to an electrical signal that is transmitted through a wire system
to a fetal monitor where the uterine activity is displayed graphically on the fetal monitor tracing
Sensor-tipped: Air-coupling technology, which is a newer method of IUPC monitoring, uses a
distally mounted flexible balloon in the uterus connected to an external reusable transducer in the
monitor cable. Similar to noninvasive blood pressure monitors, this catheter consists of a
membrane sensor at the tip of the catheter that communiated pressures through a microcolumn of
air to a transducer located outside the body
What is the paper speed for EFM tracing? - Changes in paper speed can substantially alter
the appearance of the tracing. The commonly used paper in the US has markings on the vertical
, scale from 30-240 bpm with dividing lines at 10-bpm intervals. Should be set to 3cm on the
horizontal scale (slower than Europe)
What is artifact? - Irregular variations or absence of the FHR on the fetal monitor record
resulting from mechanical limitations of the monitor, electrical interference, or weak signal,
appearing as gaps or dots. With FSE, artifact may appear in the form of irregular lines with
varying lengths.
FSE artifact vs arrhythmias: arrhythmias will be regular lines
What is half-counting in regards to the FHR? - Most commonly seen when the FHR is
rapid, such as with fetal supraventricular tachycardia
What is double-counting in regards to FHR? - May occur during periods of bradycardia
What are some troubleshooting interventions for fetal monitoring? - Repositioning the US
transducer, ensuring an adequate amount of coupling gel is used, and checking for proper
placement of FSE
Check maternal pulse, encourage maternal position changes, tighten belt as needed, check
connection to the power source as well as connections to the monitor, apply FSE if clinically
indicated
What are some patient education points for fetal monitoring? - Education regarding
available and recommended methods of fetal assessment should be customized for each woman
Describe Fetal Heart Rate Monitoring - EFM may be external, internal or a combination
In the US, the majority of women have EFM during some or all of their labors
Each modality has both pros and cons
Describe Doppler Ultrasound - The doppler US transducer is used to assess FHR
characteristics and patterns. The transducer translates sound wave reflections into waveforms
which are interpreted by a computer and then exported as an audible sound and a waveform
pattern.
Problems: FHR artifact, doubling, halving, and detection of maternal heart rate
Current ultrasound FHR signal processing uses autocorrelation techniques and interpretation of
EFM data is based on this assumption
Describe internal fetal electrode - The FSE directly measures the FHR by measuring R to
R waves in successive QRS complexes. To place an FSE, adequate cervical dilation (usually at
least 2 cm) and ROM are needed.
Contraindications: placenta previa, hemophilia, maternal HIV, herpes infections, or when
presenting part is not identifiable
Problems: artifact, slight risk of fetal infection/injury, doubling or halving of the FHR, and pick
up of the MHR with fetal demise
,Other relative contraindications: syphilis, gonorrhea (not recommended but may be placed if a
clear benefit to a mother and fetus can be demonstrated by its use)
Describe external uterine monitoring - The tocotransducer (TOCO) is a pressure sensitive
button-like device that detects changes in the abdominal contour when there is a uterine
contraction. The specific location is determined by abdominal palpation and is ideally a smooth
part of the uterus where no fetal small parts are felt. Usually this is the fundus or whatever
uterine contractions are most easily palpated
The TOCO can best provide: relative strength, approximate duration, and approximate frequency
of contractions but cannot determine actual intensity. PALPATION IS ESSENTIAL
Problems: include its inherent limitations, possibility of inverted contractions and issues with
obesity
Describe internal uterine monitoring - IUPC allows for greater quantitative measurement
of uterine contraction frequency, duration, and intensity or peak intrauterine pressure and resting
tone
Three types: fluid-filled (other countries), transducer-tipped, and air-coupled or sensor-tipped
(what we used)
Measures: actual pressures in mmHg and most allow for amnioinfustion
,Indications for use: Need for amnioinfusion, titration of oxytocin for induction or augmentation
when external methods are not providing enough information, and lack of progress in labor
Problems: user error, displacement, placental abruption/shearing, and a small risk of uterine
perforation
What are the three types of IUPC monitors? - Fluid-filled: also called the water column
method, was the 1st type of IUPC available and use dramatically decreased after introduction of
the transducer-tipped catheter. It works by transmitting the pressure generated by a contraction
through a water column to a transducer located away from the source of pressure, typically at the
monitor site. This displaced fluid exerts pressure against a diaphragm in the transducer,
generating changes in the electrical resistance of a series of wires. These electrical changes are
converted to measures of pressure.
Transducer-tipped: Introduced in the 1980s as an alternative to fluid-filled. The force exerted by
a uterine contraction is converted to an electrical signal that is transmitted through a wire system
to a fetal monitor where the uterine activity is displayed graphically on the fetal monitor tracing
Sensor-tipped: Air-coupling technology, which is a newer method of IUPC monitoring, uses a
distally mounted flexible balloon in the uterus connected to an external reusable transducer in the
monitor cable. Similar to noninvasive blood pressure monitors, this catheter consists of a
membrane sensor at the tip of the catheter that communiated pressures through a microcolumn of
air to a transducer located outside the body
What is the paper speed for EFM tracing? - Changes in paper speed can substantially alter
the appearance of the tracing. The commonly used paper in the US has markings on the vertical
, scale from 30-240 bpm with dividing lines at 10-bpm intervals. Should be set to 3cm on the
horizontal scale (slower than Europe)
What is artifact? - Irregular variations or absence of the FHR on the fetal monitor record
resulting from mechanical limitations of the monitor, electrical interference, or weak signal,
appearing as gaps or dots. With FSE, artifact may appear in the form of irregular lines with
varying lengths.
FSE artifact vs arrhythmias: arrhythmias will be regular lines
What is half-counting in regards to the FHR? - Most commonly seen when the FHR is
rapid, such as with fetal supraventricular tachycardia
What is double-counting in regards to FHR? - May occur during periods of bradycardia
What are some troubleshooting interventions for fetal monitoring? - Repositioning the US
transducer, ensuring an adequate amount of coupling gel is used, and checking for proper
placement of FSE
Check maternal pulse, encourage maternal position changes, tighten belt as needed, check
connection to the power source as well as connections to the monitor, apply FSE if clinically
indicated
What are some patient education points for fetal monitoring? - Education regarding
available and recommended methods of fetal assessment should be customized for each woman
