FETAL HEALTH SURVEILLANCE EXAM
QUESTIONS AND ANSWERS GRADED A+
2026
Tachysystole - ANS Any excessive uterine activity (UA); >5 contractions in a 10 minute
window, averaged over 30 mins.
Repetitive Decelerations - ANS 3 or more decels in a row
Recurrent Decelerations - ANS Decels that occur with >50% of contractions in a 20 minute
period
Intermittent Decelerations - ANS Decels that occur with <50% of contractions in a 20 minute
period
Gradual Deceleration - ANS ≥30 seconds from onset to nadir
Episodic Gradual Deceleration - ANS A gradual decel NOT associated with a contraction
Interpretable Electronic Fetal Monitoring - ANS Electronic fetal monitoring tracing that has a
continuous display of the fetal heart rate and uterine activity with minimal gaps.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
1
,Uterine Activity - How is this documented? - ANS Number of contractions present in a 10-
minute window, averaged over 30 minutes (e.g. 3 contractions in 10 minutes) - UNLESS
atypical/abnormal in the first 10 minutes of tachysystole - initiate a response without averaging
over 30 minutes
Recommended (minimum) tracing for EFM - ANS 20 Minutes
Early Deceleration - ANS *safe*. Begin prior to peak of the contraction and end by the end of
it. Caused by head compression (E.G associated with fetal descent in the pelvis / full dilation).
No need for intervention if variability is within normal range and the FHR is within normal
range. Characteristic of nadir occurring at same time as peak of contraction. *Usually
symmetrical*. Return to normal by end of contraction.
**Early decelerations are said to be a mirror image of the contractions.**
Uncomplicated variable deceleration - ANS Caused by cord compression. 15 BPM below
baseline lasting >15s. Often have shoulders (initial accel, followed by rapid decel to the nadir,
rapid return to baseline, followed by secondary brief accel). Common in late 1st stage.
*NORMAL* if occasional uncomplicated variable decelerations occur
*ATYPICAL* if repetitive (greater than or equal to 3) uncomplicated variable decelerations occur
Complicated Variable Deceleration - ANS *Not ok - May be indicative of fetal hypoxia /
acidemia* Also caused by cord compression, but does not return to baseline by end of
contraction. Any of: May last >60s AND go down to <60BPM OR decrease by >60BPM below
baseline; overshoot of 20BPM X 20secs after decel; variable decel in presence of minimal or
absent baseline variability, OR baseline tachycardia/ bradycardia. Can occur in 1st or 2nd stage.
Late decelerations - ANS *Also not ok - indicates uteroplacental insufficiency, or decreased
uteroplacental blood flow during contraction / associated with fetal hypoxia and acidemia* . =
lowered fetal pO2.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
2
, Symmetrical - gradual drop and return to baseline, but unlike early decels, the onset, nadir and
recovery occurs AFTER the peak of the contraction.
**Gradual, smooth, delayed deceleration**
IA during 1st stage - how often? - ANS q15 mins
IA during 2nd stage - how often? - ANS q5 mins
EFM During 2nd stage - interpret how often? - ANS At least q15mins, otherwise q5mins
Spontaneous Accelerations - ANS *Good* - Reassuring, but not required to classify EFM as
'normal'.
Recommended in Response to atypical EFM and abnormal IA - ANS Digital Fetal Scalp
Stimulation
Primary factors that regulate the FHR - ANS The medulla oblongata (in the brainstem), the
autonomic nervous system, baroreceptors, and chemoreceptors
Secondary factors that regulate the FHR - ANS Humoral or endocrine factors, blood
composition and volume, blood vessel diameter, cardiac contractility and amniotic fluid
composition, as well as substances released from the: hypothalamus, pituitary gland, adrenal
glands, adipose tissue, pancreas, kidneys, intestines, liver, spleen, bone marrow and heart
CNS - Medulla Oblongata... - ANS Serves as the integrative centre for central and peripheral
neural control of the cardiovascular and respiratory system. Blood pressure, heart rate, and
vascular resistance are controlled at this level.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
3
QUESTIONS AND ANSWERS GRADED A+
2026
Tachysystole - ANS Any excessive uterine activity (UA); >5 contractions in a 10 minute
window, averaged over 30 mins.
Repetitive Decelerations - ANS 3 or more decels in a row
Recurrent Decelerations - ANS Decels that occur with >50% of contractions in a 20 minute
period
Intermittent Decelerations - ANS Decels that occur with <50% of contractions in a 20 minute
period
Gradual Deceleration - ANS ≥30 seconds from onset to nadir
Episodic Gradual Deceleration - ANS A gradual decel NOT associated with a contraction
Interpretable Electronic Fetal Monitoring - ANS Electronic fetal monitoring tracing that has a
continuous display of the fetal heart rate and uterine activity with minimal gaps.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
1
,Uterine Activity - How is this documented? - ANS Number of contractions present in a 10-
minute window, averaged over 30 minutes (e.g. 3 contractions in 10 minutes) - UNLESS
atypical/abnormal in the first 10 minutes of tachysystole - initiate a response without averaging
over 30 minutes
Recommended (minimum) tracing for EFM - ANS 20 Minutes
Early Deceleration - ANS *safe*. Begin prior to peak of the contraction and end by the end of
it. Caused by head compression (E.G associated with fetal descent in the pelvis / full dilation).
No need for intervention if variability is within normal range and the FHR is within normal
range. Characteristic of nadir occurring at same time as peak of contraction. *Usually
symmetrical*. Return to normal by end of contraction.
**Early decelerations are said to be a mirror image of the contractions.**
Uncomplicated variable deceleration - ANS Caused by cord compression. 15 BPM below
baseline lasting >15s. Often have shoulders (initial accel, followed by rapid decel to the nadir,
rapid return to baseline, followed by secondary brief accel). Common in late 1st stage.
*NORMAL* if occasional uncomplicated variable decelerations occur
*ATYPICAL* if repetitive (greater than or equal to 3) uncomplicated variable decelerations occur
Complicated Variable Deceleration - ANS *Not ok - May be indicative of fetal hypoxia /
acidemia* Also caused by cord compression, but does not return to baseline by end of
contraction. Any of: May last >60s AND go down to <60BPM OR decrease by >60BPM below
baseline; overshoot of 20BPM X 20secs after decel; variable decel in presence of minimal or
absent baseline variability, OR baseline tachycardia/ bradycardia. Can occur in 1st or 2nd stage.
Late decelerations - ANS *Also not ok - indicates uteroplacental insufficiency, or decreased
uteroplacental blood flow during contraction / associated with fetal hypoxia and acidemia* . =
lowered fetal pO2.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
2
, Symmetrical - gradual drop and return to baseline, but unlike early decels, the onset, nadir and
recovery occurs AFTER the peak of the contraction.
**Gradual, smooth, delayed deceleration**
IA during 1st stage - how often? - ANS q15 mins
IA during 2nd stage - how often? - ANS q5 mins
EFM During 2nd stage - interpret how often? - ANS At least q15mins, otherwise q5mins
Spontaneous Accelerations - ANS *Good* - Reassuring, but not required to classify EFM as
'normal'.
Recommended in Response to atypical EFM and abnormal IA - ANS Digital Fetal Scalp
Stimulation
Primary factors that regulate the FHR - ANS The medulla oblongata (in the brainstem), the
autonomic nervous system, baroreceptors, and chemoreceptors
Secondary factors that regulate the FHR - ANS Humoral or endocrine factors, blood
composition and volume, blood vessel diameter, cardiac contractility and amniotic fluid
composition, as well as substances released from the: hypothalamus, pituitary gland, adrenal
glands, adipose tissue, pancreas, kidneys, intestines, liver, spleen, bone marrow and heart
CNS - Medulla Oblongata... - ANS Serves as the integrative centre for central and peripheral
neural control of the cardiovascular and respiratory system. Blood pressure, heart rate, and
vascular resistance are controlled at this level.
@COPYRIGHT 2026/2027 ALL RIGHTS RESERVED
3
