NCC EFM Exam Questions and Answers
(2026/2027) | Review Pack | Exam Practice
| A+
• Oligohydramnios. CORRECT ANSWER: single MVP < 2 cm or AFI < 5 at term (less
than 5%ile); associated with FGR, placental abnormalities, urinary tract abnormalities,
post-term pregnancies, ruptured or idiopathic membranes
• Doppler. CORRECT ANSWER: US transducer, depicts valve closure; uses
autocorrelation
• Autocorrelation. CORRECT ANSWER: successive US waveforms at many points;
current technology which is more accurate at detecting FHR variability; controls artifact
sound waves
• Toco/tocotransducer. CORRECT ANSWER: detects change in contour with
contractions; place at fundus or at area of maximum palpation; difficult to measure with
obesity, polyhydramnios
• Fetal scalp electrode measures. CORRECT ANSWER: R-R waves; still has issues
with artifact; risk of injury, measuring maternal HR in instance of fetal demise; rupture
and dilation required
• IUPC. CORRECT ANSWER: solid>fluid filled tips, measures mmHg and allows
amnioinfusion; issue with displacement, perforation, placental abruption
• Intermittent auscultation. CORRECT ANSWER: goal is baseline 110-160, +/-accels,
no decels; if present, put on continuous monitor min 20 minutes); cannot determine
variability or types of FHR decels
• Active phase auscultation. CORRECT ANSWER: q15 min for high risk up to q30min
• Second stage auscultation. CORRECT ANSWER: q5 min if high risk up to q15min
• Fetal tolerance of labor. CORRECT ANSWER: auscultate after a contraction x 30-60
seconds; document rate, rhythm, accels, decels
• Doppler vs. fetoscope. CORRECT ANSWER: doppler uses autocorrelation and
detects valve closure; fetoscope listens through opening in heart wall?
• Signal ambiguity. CORRECT ANSWER: confusing maternal and fetal heart rate;
common with repositioning, fetal movement, during pushing (maternal tachycardia); can
occur even with fetal demise due to FSE recording maternal blood flow through the
placenta
,• Suspect signal ambiguity. CORRECT ANSWER: when there is lower baseline or
>50% contractions with accelerations (especially with pushing); verify and document
maternal heart rate via pulse oximetry
• Halving/doubling. CORRECT ANSWER: Halving occurs if FHR >180-200; may double
if rate <50
• Extrinsic factors. CORRECT ANSWER: maternal oxygenation, uterine blood flow,
placenta exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation
of tissues, FHR regulation
• Primary source of oxygen for the feus. CORRECT ANSWER: the maternal respiratory
system
• Uterine blood flow. CORRECT ANSWER: 60ml/min non-pregnant vs. 500-1000ml/min;
10-15% maternal cardiac output
• Normal blood flow pathway. CORRECT ANSWER: Blood from maternal vein >
intervillous pool of maternal blood > umbilical vein (oxygenated blood)
• Normal placenta. CORRECT ANSWER: Placenta has 15-20 lobules on maternal
surface; Decreased surface area of chorionic villi from abnormal development, infection,
thrombosis, hemorrhage, inflammation (chorio increases risk of CP), degenerative
changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR,
hypoxia, FHR decels
• Acute drop in placental function. CORRECT ANSWER: fetal asphyxia
• Chronic drop in placental function. CORRECT ANSWER: FGR
• O2 and CO2. CORRECT ANSWER: simple transport (diffusion); electrolytes, fat
soluble vitamins, narcotics, anesthetic gasses, antibiotics
• Glucose. CORRECT ANSWER: facilitated transport, by carrier molecules
• Active. CORRECT ANSWER: amino acids, calcium, iron, water soluble vitamins (uses
ATP)
• Umbilical blood flow. CORRECT ANSWER: 2 arteries (deoxygenated) and 1 vein
(oxygenation)
• Fetal circulation. CORRECT ANSWER: when compromised, fetal blood redistributed
to heart, brain, adrenals; shunting and FHR increase compensate for decreased blood
flow and hypoxemia; limit mixing of oxygenated and deoxygenated blood
, • Fetal hemoglobin. CORRECT ANSWER: AND increased O2 affinity > adult; fetus has
increased cardiac output and heart rate
• Ductus venosus. CORRECT ANSWER: (highest oxygenation) > ductus arteriosus
(least oxygenation);
• Abrupt decrease in PO2 leads to. CORRECT ANSWER: 2-3x increase to heart, brain,
adrenals; decrease to gut, spleen, kidneys, limbs
• Severe acidemia. CORRECT ANSWER: decrease CO2, BP, and decreased blood
flow to brain and heart > tissue damage, fetal death
• Oxygenation depletion cascade. CORRECT ANSWER: aerobic metabolism >
hypoxemia > tissue hypoxia > anaerobic metabolism > lactic acid > metabolic acidosis
• FHR regulation. CORRECT ANSWER: Parasympathetic slows, sympathetic speeds
FHR
• Sympathetic. CORRECT ANSWER: nerve fibers in myocardium, norepi/epi, increases
BP and shunting to brain, heart, adrenals
• Marked variability mediated by. CORRECT ANSWER: adrenergic activity
(epinephrine)
• Parasympathetic. CORRECT ANSWER: vagus nerve, acetylcholine; PS tone
increases as gestational age increases and decreases FHR baseline and increases
FHR variability, requires mature nervous system (why FHR baseline decreases by 10
bpm from 30 to 40 weeks)
• Variability. CORRECT ANSWER: intact pathway from brain > vagus nerve > fetal
cardiac system
• Moderate FHR variability. CORRECT ANSWER: predicts absent metabolic acidemia
at the moment it is observed; indicates that fetus is adequately oxygenated at that time
• Baroreceptors and chemoreceptors. CORRECT ANSWER: located in aortic arch and
carotid sinus; both involve parasympathetic and sympathetic systems
• Baroreceptors. CORRECT ANSWER: variable decelerations. Abrupt fetal BP increase
> baroreceptors fire > cardioinhibitory center > vagal response > decrease HR,
decrease CO; When BP drops, sympathetic stimulations and FHR increases
• Chemoreceptors. CORRECT ANSWER: late decelerations (and bad variables)
response to hypoxemia; lower blood flow > increased PCO2 > chemoreceptors slow
FHR. Initial FHR response to fall in pH may be rising baseline (baby overcompensates).
(2026/2027) | Review Pack | Exam Practice
| A+
• Oligohydramnios. CORRECT ANSWER: single MVP < 2 cm or AFI < 5 at term (less
than 5%ile); associated with FGR, placental abnormalities, urinary tract abnormalities,
post-term pregnancies, ruptured or idiopathic membranes
• Doppler. CORRECT ANSWER: US transducer, depicts valve closure; uses
autocorrelation
• Autocorrelation. CORRECT ANSWER: successive US waveforms at many points;
current technology which is more accurate at detecting FHR variability; controls artifact
sound waves
• Toco/tocotransducer. CORRECT ANSWER: detects change in contour with
contractions; place at fundus or at area of maximum palpation; difficult to measure with
obesity, polyhydramnios
• Fetal scalp electrode measures. CORRECT ANSWER: R-R waves; still has issues
with artifact; risk of injury, measuring maternal HR in instance of fetal demise; rupture
and dilation required
• IUPC. CORRECT ANSWER: solid>fluid filled tips, measures mmHg and allows
amnioinfusion; issue with displacement, perforation, placental abruption
• Intermittent auscultation. CORRECT ANSWER: goal is baseline 110-160, +/-accels,
no decels; if present, put on continuous monitor min 20 minutes); cannot determine
variability or types of FHR decels
• Active phase auscultation. CORRECT ANSWER: q15 min for high risk up to q30min
• Second stage auscultation. CORRECT ANSWER: q5 min if high risk up to q15min
• Fetal tolerance of labor. CORRECT ANSWER: auscultate after a contraction x 30-60
seconds; document rate, rhythm, accels, decels
• Doppler vs. fetoscope. CORRECT ANSWER: doppler uses autocorrelation and
detects valve closure; fetoscope listens through opening in heart wall?
• Signal ambiguity. CORRECT ANSWER: confusing maternal and fetal heart rate;
common with repositioning, fetal movement, during pushing (maternal tachycardia); can
occur even with fetal demise due to FSE recording maternal blood flow through the
placenta
,• Suspect signal ambiguity. CORRECT ANSWER: when there is lower baseline or
>50% contractions with accelerations (especially with pushing); verify and document
maternal heart rate via pulse oximetry
• Halving/doubling. CORRECT ANSWER: Halving occurs if FHR >180-200; may double
if rate <50
• Extrinsic factors. CORRECT ANSWER: maternal oxygenation, uterine blood flow,
placenta exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation
of tissues, FHR regulation
• Primary source of oxygen for the feus. CORRECT ANSWER: the maternal respiratory
system
• Uterine blood flow. CORRECT ANSWER: 60ml/min non-pregnant vs. 500-1000ml/min;
10-15% maternal cardiac output
• Normal blood flow pathway. CORRECT ANSWER: Blood from maternal vein >
intervillous pool of maternal blood > umbilical vein (oxygenated blood)
• Normal placenta. CORRECT ANSWER: Placenta has 15-20 lobules on maternal
surface; Decreased surface area of chorionic villi from abnormal development, infection,
thrombosis, hemorrhage, inflammation (chorio increases risk of CP), degenerative
changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR,
hypoxia, FHR decels
• Acute drop in placental function. CORRECT ANSWER: fetal asphyxia
• Chronic drop in placental function. CORRECT ANSWER: FGR
• O2 and CO2. CORRECT ANSWER: simple transport (diffusion); electrolytes, fat
soluble vitamins, narcotics, anesthetic gasses, antibiotics
• Glucose. CORRECT ANSWER: facilitated transport, by carrier molecules
• Active. CORRECT ANSWER: amino acids, calcium, iron, water soluble vitamins (uses
ATP)
• Umbilical blood flow. CORRECT ANSWER: 2 arteries (deoxygenated) and 1 vein
(oxygenation)
• Fetal circulation. CORRECT ANSWER: when compromised, fetal blood redistributed
to heart, brain, adrenals; shunting and FHR increase compensate for decreased blood
flow and hypoxemia; limit mixing of oxygenated and deoxygenated blood
, • Fetal hemoglobin. CORRECT ANSWER: AND increased O2 affinity > adult; fetus has
increased cardiac output and heart rate
• Ductus venosus. CORRECT ANSWER: (highest oxygenation) > ductus arteriosus
(least oxygenation);
• Abrupt decrease in PO2 leads to. CORRECT ANSWER: 2-3x increase to heart, brain,
adrenals; decrease to gut, spleen, kidneys, limbs
• Severe acidemia. CORRECT ANSWER: decrease CO2, BP, and decreased blood
flow to brain and heart > tissue damage, fetal death
• Oxygenation depletion cascade. CORRECT ANSWER: aerobic metabolism >
hypoxemia > tissue hypoxia > anaerobic metabolism > lactic acid > metabolic acidosis
• FHR regulation. CORRECT ANSWER: Parasympathetic slows, sympathetic speeds
FHR
• Sympathetic. CORRECT ANSWER: nerve fibers in myocardium, norepi/epi, increases
BP and shunting to brain, heart, adrenals
• Marked variability mediated by. CORRECT ANSWER: adrenergic activity
(epinephrine)
• Parasympathetic. CORRECT ANSWER: vagus nerve, acetylcholine; PS tone
increases as gestational age increases and decreases FHR baseline and increases
FHR variability, requires mature nervous system (why FHR baseline decreases by 10
bpm from 30 to 40 weeks)
• Variability. CORRECT ANSWER: intact pathway from brain > vagus nerve > fetal
cardiac system
• Moderate FHR variability. CORRECT ANSWER: predicts absent metabolic acidemia
at the moment it is observed; indicates that fetus is adequately oxygenated at that time
• Baroreceptors and chemoreceptors. CORRECT ANSWER: located in aortic arch and
carotid sinus; both involve parasympathetic and sympathetic systems
• Baroreceptors. CORRECT ANSWER: variable decelerations. Abrupt fetal BP increase
> baroreceptors fire > cardioinhibitory center > vagal response > decrease HR,
decrease CO; When BP drops, sympathetic stimulations and FHR increases
• Chemoreceptors. CORRECT ANSWER: late decelerations (and bad variables)
response to hypoxemia; lower blood flow > increased PCO2 > chemoreceptors slow
FHR. Initial FHR response to fall in pH may be rising baseline (baby overcompensates).
