NCC EFM EXAM (2024-2025) STUDY GUIDE
(UPDATED)
Maternal obesity - <<Answers>>>-Risk of diabetes,
preeclampsia, DVT, infection, PPH (↑ estrogen), miscarriage
-Fetus: NTD, heart defect, macrosomia (4000g, 8-13), PTD
-Recommended weight gain: 11-20 lbs (compared to 25-35 in
average weight)
Uteroplacental complications - <<Answers>>>1) Previa: total
= covering cx os, marginal = 2cm of os, low lying = 2-3.5 cm
from os (usually resolves)
-painless bright red bleeding
-risk: AMA, uterine scarring, fibroids, smoking, multiples
-pelvic rest, bedrest, rhogam (rh-), steroids, PTD
2) Abruption: placental separation from uterus
-painful bleeding (may be concealed), ↑ frequency ↓
amplitude contractions, ↑ fundal height, rigid abd
3) Uterine rupture: risk w overdistended uterus or previous
surgery (poly, LGA, TOLAC, pit)
-abrupt pain, fetal intolerance, no contractions, hematuria,
head unengaged (loss of station), chest or shoulder pain
(blood accumulation in peritoneum)
Auscultation - <<Answers>>>Intermittently listening to fetal
heart sounds w fetoscope or doppler to assess FHR
-Detects baseline, rhythm, increases & decreases from
baseline
-Cannot determine variability or classify decels
, NCC EFM EXAM (2024-2025) STUDY GUIDE
(UPDATED)
-Use of fetoscope can verify presence of arrhythmia (most
accurate) & clarifies halving or doubling
-Listen to FHR before, during, & for 30 sec after contraction
-Feel for mom's radial pulse to differentiate
Fetal movement & stimulation - <<Answers>>>-Kick count:
10 movements in 2 hrs (starting at 28 wks)
-To ↑ movement, have ice chips (auditory stimulation) or
juice (sugar)
-Do not do scalp stim when FHR is not at baseline (don't use
during a decel)
Non stress test (NST) - <<Answers>>>Can be done >26 wks
-Reactive: 2 accels in 20 mins (can prolong to 40min) with
moderate variability
-Acoustic stim: ≤3, 1 min apart lasting 3 sec each (not used
for oligo or <32 wks), elicits startle reflex
-Valid for 24 hrs
Biophysical Profile (BPP) - <<Answers>>>Normal = 2
points, abnormal = 0
-Can be done ≥28 wks, valid for 7 days
-BPP done over 30 mins
1) Fetal heart rate
2) Breathing movements
, NCC EFM EXAM (2024-2025) STUDY GUIDE
(UPDATED)
3) Gross body movements
4) Muscle tone: extension/flexion
5) Amniotic fluid volume: (>2cm or AFI >5)
Scoring a BPP - <<Answers>>>Will get 2 points for each of
the following:
-Reactive NST: 2 accles in 20min
-Breathing: 1 lasting 60 secs or 2 lasting 30 secs
-Gross movements: 3 of arms, legs, or body
-Tone: 1 flexion & extension of arms, legs, hands
-AFI: either a 2cm pocket or a total of 5cm (normal 5-25cm)
Interpretation of BPP - <<Answers>>>-8 to 10 = reassuring
(unless oligo)
-6 = equivocal, repeat in 24 hrs (if pt is term then delivery is
recommended)
-4 = further testing needed
Normal ABGs - <<Answers>>>-pH ≥7.1
-CO2 <60
-Bicarb >22
-pO2 >20
-BD <12
(UPDATED)
Maternal obesity - <<Answers>>>-Risk of diabetes,
preeclampsia, DVT, infection, PPH (↑ estrogen), miscarriage
-Fetus: NTD, heart defect, macrosomia (4000g, 8-13), PTD
-Recommended weight gain: 11-20 lbs (compared to 25-35 in
average weight)
Uteroplacental complications - <<Answers>>>1) Previa: total
= covering cx os, marginal = 2cm of os, low lying = 2-3.5 cm
from os (usually resolves)
-painless bright red bleeding
-risk: AMA, uterine scarring, fibroids, smoking, multiples
-pelvic rest, bedrest, rhogam (rh-), steroids, PTD
2) Abruption: placental separation from uterus
-painful bleeding (may be concealed), ↑ frequency ↓
amplitude contractions, ↑ fundal height, rigid abd
3) Uterine rupture: risk w overdistended uterus or previous
surgery (poly, LGA, TOLAC, pit)
-abrupt pain, fetal intolerance, no contractions, hematuria,
head unengaged (loss of station), chest or shoulder pain
(blood accumulation in peritoneum)
Auscultation - <<Answers>>>Intermittently listening to fetal
heart sounds w fetoscope or doppler to assess FHR
-Detects baseline, rhythm, increases & decreases from
baseline
-Cannot determine variability or classify decels
, NCC EFM EXAM (2024-2025) STUDY GUIDE
(UPDATED)
-Use of fetoscope can verify presence of arrhythmia (most
accurate) & clarifies halving or doubling
-Listen to FHR before, during, & for 30 sec after contraction
-Feel for mom's radial pulse to differentiate
Fetal movement & stimulation - <<Answers>>>-Kick count:
10 movements in 2 hrs (starting at 28 wks)
-To ↑ movement, have ice chips (auditory stimulation) or
juice (sugar)
-Do not do scalp stim when FHR is not at baseline (don't use
during a decel)
Non stress test (NST) - <<Answers>>>Can be done >26 wks
-Reactive: 2 accels in 20 mins (can prolong to 40min) with
moderate variability
-Acoustic stim: ≤3, 1 min apart lasting 3 sec each (not used
for oligo or <32 wks), elicits startle reflex
-Valid for 24 hrs
Biophysical Profile (BPP) - <<Answers>>>Normal = 2
points, abnormal = 0
-Can be done ≥28 wks, valid for 7 days
-BPP done over 30 mins
1) Fetal heart rate
2) Breathing movements
, NCC EFM EXAM (2024-2025) STUDY GUIDE
(UPDATED)
3) Gross body movements
4) Muscle tone: extension/flexion
5) Amniotic fluid volume: (>2cm or AFI >5)
Scoring a BPP - <<Answers>>>Will get 2 points for each of
the following:
-Reactive NST: 2 accles in 20min
-Breathing: 1 lasting 60 secs or 2 lasting 30 secs
-Gross movements: 3 of arms, legs, or body
-Tone: 1 flexion & extension of arms, legs, hands
-AFI: either a 2cm pocket or a total of 5cm (normal 5-25cm)
Interpretation of BPP - <<Answers>>>-8 to 10 = reassuring
(unless oligo)
-6 = equivocal, repeat in 24 hrs (if pt is term then delivery is
recommended)
-4 = further testing needed
Normal ABGs - <<Answers>>>-pH ≥7.1
-CO2 <60
-Bicarb >22
-pO2 >20
-BD <12
