NCC EFM Exam Breakdown & Study
Guide
Content on exam VERIFIED ANS: -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention VERIFIED ANS: -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors VERIFIED ANS: 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
,FHR Baseline VERIFIED ANS: Average FHR rounded to nearest 5 during a 10 min window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia VERIFIED ANS: <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital defect, rapid descent,
abruption or rupture, tachysystole, post dates, hypoglycemia, lupus (heart block)
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR to ↓ O2 demands of
heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate arrhythmia, expedite delivery
Fetal Tachycardia VERIFIED ANS: >160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm), SVT, maternal anxiety
(catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability VERIFIED ANS: Irregular in amplitude & frequency, quantified by peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability VERIFIED ANS: ≤5 bpm but detectable
, Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability VERIFIED ANS: 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations VERIFIED ANS: Reliably predicts absence of metabolic acidemia (spontaneous or
stimulated)
-Onset to peak in <30 sec
-For ≥32 wks: 15x15 (peak ≥15 bpm above baseline lasting ≥15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration VERIFIED ANS: Nadir aligns w contraction peak, gradual onset (≥30 secs to nadir),
benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
Periodic vs Episodic VERIFIED ANS: Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
Guide
Content on exam VERIFIED ANS: -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention VERIFIED ANS: -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors VERIFIED ANS: 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
,FHR Baseline VERIFIED ANS: Average FHR rounded to nearest 5 during a 10 min window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia VERIFIED ANS: <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital defect, rapid descent,
abruption or rupture, tachysystole, post dates, hypoglycemia, lupus (heart block)
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR to ↓ O2 demands of
heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate arrhythmia, expedite delivery
Fetal Tachycardia VERIFIED ANS: >160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm), SVT, maternal anxiety
(catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability VERIFIED ANS: Irregular in amplitude & frequency, quantified by peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability VERIFIED ANS: ≤5 bpm but detectable
, Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability VERIFIED ANS: 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations VERIFIED ANS: Reliably predicts absence of metabolic acidemia (spontaneous or
stimulated)
-Onset to peak in <30 sec
-For ≥32 wks: 15x15 (peak ≥15 bpm above baseline lasting ≥15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration VERIFIED ANS: Nadir aligns w contraction peak, gradual onset (≥30 secs to nadir),
benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
Periodic vs Episodic VERIFIED ANS: Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
