NCC EFM EXAM QUESTIONS WITH ANSWERS LATEST VERIFIED 2023/2024 (GRADED)

Causes of uteroplacental perfusion decrease: - correct answers• HTN • Pregnancy • DM • Hypotension • Excessive uterine contractions (hypertonus) • Decreased surface area, edema, degenerative calcifications, infarcts, infection FHR reflects fetal oxygenation from which extrinsic factors: - correct answers• Maternal oxygenation • Uterine blood flow • Placental change • Umbilical blood flow FHR reflects oxygenation from which intrinsic factors: - correct answers• Fetal circulation • Oxygenation of tissues • FHR regulation Fetal shunts: - correct answers• Ductus venosus- liver • PFO- Right to left atria • Ductus arteriosis- pulmonary a. to aorta Oxygen depletion cascade: - correct answers• Aerobic metabolism • Hypoxemia • Tissue hypoxia • Anaerobic metabolism • Lactic acid build up • Metabolic acidosis Sympathetic innervation: - correct answers• Releases Eip/norepi • Increases FHR Parasympathetic/Vagal innervation: - correct answers• Releases ach • Decreases FHR and transmits variability Early decel: - correct answers• Fetal head compression • -vasovagal response Variable decel: - correct answers• Cord compression • -increase BP/HTN • -activation of baroreceptor • -decrease FHR, BP, and CO Late decel: - correct answers• Inadequate uteroplacental blood flow-decreased maternal fetal O2 transfer • -activation of chemoreceptors to respond due to increased PCO2, decreased PO2, and decreased pH • -Fetal bradycardia and hypertension Category I: - correct answers• Normal fetal acid base status • All the following are required: • Moderate variability • Baseline rate 110-160 • Late or variable decels are absent • Early decels present or absent • Accels present or absent Category II: - correct answers• Indeterminate compensatory response • Not category I or II Category III: - correct answers• Abnormal fetal acid-base status • Either required • Absent variability with: o Recurrent late decels, or o Recurrent variable decels, or o Bradycardia • Sinusoidal pattern In-Utero resuscitation: - correct answers• Change maternal position • Decrease uterine activity • IV fluid bolus • Correct maternal hypotension • Oxygen administration • Amnioinfusion • Alteration in 2nd stage maternal pushing efforts • If prolapsed cord, then elevate fetal presenting part while moving toward operative birth Baseline FHR: - correct answers• Approximate mean FHR excluding accelerations and decelerations or periods of marked variability (25 bpm) • Minimum of 2 minutes of identifiable BL segments in any 10 min window • May need to refer to previous 10 min window Baseline variability: - correct answers• Irregular fluctuation in baseline FHR in both amplitude and frequency • Absent- Undetectable • Minimal- 0-5 • Moderate- 6-25 • Marked 25 - alpha-adrenergic response to decreased uteroplacental blood flow or ephedrine Causes of minimal variability: - correct answers• General anesthesia • Smoking • Quiet sleep • Mag • Acidemia Prolonged acceleration: - correct answers• =2 min and 10 min FHR accelerations: - correct answers• =32- 15x15 • 32- 10x10 Scalp or vibroacoustic stimulation assures a fetal pH of: - correct answers• =7.19 Recurrent: - correct answers• Occur with =50% of contractions in any 20 min window Intermittent: - correct answers• Occur with 50% of contractions in any 20 min window Early decel definition: - correct answers• Usually symmetrical gradual decrease (onset to nadir 30 sec) and return to baseline FHR associated with uterine ctx • Nadir occurs at same time as peak of contraction