NCC EFM Exam Breakdown and Study Guide with Answers (72 Solved Questions)

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NCC EFM Exam Breakdown & StudyGuide With SolutionContent 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✓-Normal uterine activity✓-Abnormal uterine activity✓-Fetal dysrhythmias✓-Maternal complications✓-Uteroplacental complications✓-Fetal complications✓FHR Descriptors - ANSWER 1) Baseline

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2) Variability3) Presence of accels4) Presence of decels5) Changes in trends overtimeFHR Baseline - ANSWER Average FHR rounded to nearest 5 during a 10 minwindow-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 - ANSWER <110 for≥10 min-Causes: hypotension (ex: after epi), cord prolapse, head compression,congenital defect, rapid descent, abruption or rupture, tachysystole, postdates, hypoglycemia, lupus (heart block)-With↓O2, blood will be shunted to brain, heart, & adrenals, eventually↓FHRto↓O2 demands of heart muscle-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluatearrhythmia, expedite deliveryFetal Tachycardia - ANSWER >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)

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FHR Variability - ANSWER Irregular in amplitude & frequency, quantified bypeak 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 unknownMinimal variability - ANSWER≤5 bpm but detectableSleep, 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 - ANSWER 6 to 25 bpm-Reliably predicts the absence of metabolic acidosis (even w decels)FHR Accelerations - ANSWER 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)

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-For <32 wks: 10x10-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)Early deceleration - ANSWER Nadir aligns w contraction peak, gradual onset(≥30 secs to nadir), benign vagal response1) Pressure on fetal head2) Increased intracranial pressure3) Alteration in cerebral blood flow4) Central vagal stimulation5) FHR decelerationPeriodic vs Episodic - ANSWER Periodic: caused by contractions-recurrent: occurs w≥50% of contractions in 20 min-intermittent: w <50% of contractions in 20 minsEpisodic: spontaneousVariable deceleration - ANSWER Caused by cord compression-Interventions: position change, amnioinfusion-Abrupt onset: <30 seconds from onset to nadir dropping≥15 bpm lasting 15secs to <2min-Transient rise in PCO2 & fall in PO2Mechanisms of variable decelerations - ANSWER Abruptness r/t pressurechanges

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1) Vein obstruction→reflex tachy-↓venous return & cardiac output→hypotens→baroreceptor reflex↑in FHRto maintain BP2) Arterial obstruction→decreased FHR-obstructed blood flow back to placenta→HTN→baroreceptor reflex ofslowing FHR to maintain BPLate 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 venacava & aorta), fluid bolus (perfusion), O2, avoid tachysystoleMechanisms of a late deceleration - ANSWER Low O2→chemoreceptorresponse peripheral vasoconstriction→blood flow to vital organs→HTN→baroreceptor vagal stimulation→FHR decel1) Decreased uteroplacental oxygenation (transient hypoxemia)2) Chemoreceptor stimulation3) Alpha adrenergic response (catecholamines, peripheral vasoconstriction)4) Fetal HTN5) Baroreceptor stimulation6) Parasympathetic response7) FHR deceleration8)↓myocardial stress

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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, profoundcord compression, uterine ruptureSinusoidal pattern - ANSWER Visually apparent, smooth, sine wave-likepattern 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)Interventions - ANSWER -Position change: off of vena cava & aorta, leastinvasive, 1st line of treatment-Fluid bolus-Amnioinfusion (for variables)-Tocolytics (terb)-Ephedrine to↑BP-Supplemental O2: not used w O2 >95%, can cause vasoconstriction, freeradical formation, ocular toxicity if used limit to 15-30minCategory I tracing - ANSWER Normal acid base balance-Baseline between 110 to 160

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-Moderate variability-No late, variable, or prolonged decels-May have early decels-May or may not have accelsCategory II tracing - ANSWER Indeterminate acid base balance-Minimal variability-Marked variability-Late or variable decels-Bradycardia with variability-Tachycardia-Prolonged decels-Absent variability w NO decels-Absence of induced acccel WITH fetal stimulationCategory III tracing - ANSWER Predictive of abnormal acid base balance at thatmoment-Sinusoidal rhythm: has to last≥20min, r/t anemia (previa, bleeding,abruption)-Absent variability WITH one of the following: bradycardia, recurrent late orrecurrent variable decels-Decide for c/s within 30minNormal uterine activity - ANSWER≤5 contractions in 10 mins averaging over

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