NCC EFM EXAM BREAKDOWN & COMPLETE
STUDY GUIDE QUESTIONS AND ANSWERS
LATEST 2025-2026 UPDATE
Periodic vs Episodic - Answer-Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
Variable deceleration - Answer-Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping ≥15 bpm
lasting 15 secs to <2min
-Transient rise in PCO2 & fall in PO2
Mechanisms of variable decelerations - Answer-Abruptness r/t pressure
changes
1) Vein obstruction → reflex tachy
-↓ venous return & cardiac output → hypotens → baroreceptor reflex ↑
in FHR to maintain BP
2) Arterial obstruction → decreased FHR
-obstructed blood flow back to placenta → HTN → baroreceptor reflex
of slowing FHR to maintain BP
,Late decelerations - Answer-Uteroplacental insufficiency
-Indicative of transient fetal hypoxemia
-Gradual onset: ≥30 secs to nadir w nadir occurring after peak of
contraction
-Priority is to maximize uteroplacental blood flow: position lateral (off
vena cava & aorta), fluid bolus (perfusion), O2, avoid tachysystole
Mechanisms of a late deceleration - Answer-Low O2 → chemoreceptor
response peripheral vasoconstriction → blood flow to vital organs →
HTN → baroreceptor vagal stimulation → FHR decel
1) Decreased uteroplacental oxygenation (transient hypoxemia)
2) Chemoreceptor stimulation
3) Alpha adrenergic response (catecholamines, peripheral
vasoconstriction)
4) Fetal HTN
5) Baroreceptor stimulation
6) Parasympathetic response
7) FHR deceleration
8) ↓ myocardial stress
Prolonged deceleration - Answer-Decrease of ≥15 bpm lasting 2 to 9
mins (≥10 = change of baseline)
-Vagal stimulation
, -Causes: hypotension, maternal hypoxia, cord prolapse, rapid decent,
profound cord compression, uterine rupture
Sinusoidal pattern - Answer-Visually apparent, smooth, sine wave-like
pattern in FHR lasting ≥20 minutes
-oscillation frequency: 3-5 cycles/min
-no variability classification or reactivity
-r/t severe anemia: previa, hemorrhage, abruption, RH isoimmunization,
asphyxia, infection, cardiac anomaly, twin to twin transfusion,
gastroschesis
-Transient if <20min, can be r/t thumb sucking or opioids (stadol,
fentanyl)
Content on exam - Answer--Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Answer--FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
STUDY GUIDE QUESTIONS AND ANSWERS
LATEST 2025-2026 UPDATE
Periodic vs Episodic - Answer-Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
Variable deceleration - Answer-Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping ≥15 bpm
lasting 15 secs to <2min
-Transient rise in PCO2 & fall in PO2
Mechanisms of variable decelerations - Answer-Abruptness r/t pressure
changes
1) Vein obstruction → reflex tachy
-↓ venous return & cardiac output → hypotens → baroreceptor reflex ↑
in FHR to maintain BP
2) Arterial obstruction → decreased FHR
-obstructed blood flow back to placenta → HTN → baroreceptor reflex
of slowing FHR to maintain BP
,Late decelerations - Answer-Uteroplacental insufficiency
-Indicative of transient fetal hypoxemia
-Gradual onset: ≥30 secs to nadir w nadir occurring after peak of
contraction
-Priority is to maximize uteroplacental blood flow: position lateral (off
vena cava & aorta), fluid bolus (perfusion), O2, avoid tachysystole
Mechanisms of a late deceleration - Answer-Low O2 → chemoreceptor
response peripheral vasoconstriction → blood flow to vital organs →
HTN → baroreceptor vagal stimulation → FHR decel
1) Decreased uteroplacental oxygenation (transient hypoxemia)
2) Chemoreceptor stimulation
3) Alpha adrenergic response (catecholamines, peripheral
vasoconstriction)
4) Fetal HTN
5) Baroreceptor stimulation
6) Parasympathetic response
7) FHR deceleration
8) ↓ myocardial stress
Prolonged deceleration - Answer-Decrease of ≥15 bpm lasting 2 to 9
mins (≥10 = change of baseline)
-Vagal stimulation
, -Causes: hypotension, maternal hypoxia, cord prolapse, rapid decent,
profound cord compression, uterine rupture
Sinusoidal pattern - Answer-Visually apparent, smooth, sine wave-like
pattern in FHR lasting ≥20 minutes
-oscillation frequency: 3-5 cycles/min
-no variability classification or reactivity
-r/t severe anemia: previa, hemorrhage, abruption, RH isoimmunization,
asphyxia, infection, cardiac anomaly, twin to twin transfusion,
gastroschesis
-Transient if <20min, can be r/t thumb sucking or opioids (stadol,
fentanyl)
Content on exam - Answer--Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Answer--FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
