CEFM ACTUAL TEST PAPER QUESTIONS
AND ANSWERS VERIFIED REVIEW
●● Describe Doppler Ultrasound
Answer: 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
Answer: 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
Answer: 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
Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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?
AND ANSWERS VERIFIED REVIEW
●● Describe Doppler Ultrasound
Answer: 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
Answer: 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
Answer: 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
Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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?
