NCC EFM EXAM 2022/2023 - QUESTIONS AND
ANSWERS
Why use fetal monitoring? Ans ~ Primary goal is to prevent fetal and
maternal morbidity and mortality (prevent injury and death to mother and/
or baby), to prevent bad patient outcomes.
What percent of babies who experience a suboptimal event while being fetal
monitored, develop cerebral palsy? Ans ~ 3% of babies with poor tracing
develop cerebral palsy
What are most sentinel events due to? Ans ~ Poor communication
between providers. Most errors are traceable back to communication errors.
Sentinel events Ans ~ bad things that happen to patients due to a
human or equipment error, and not due to the reason that they came into
the hospital (disease process)
Equipment Ans ~ your hands (palpation) use fingertips, ultrasound
transducer, FSE, tocodynamometer, Intrauterine Pressure Catheter,
Auscultation (fetoscope, hand held doppler device).
What if you can not get contractions? Ans ~ palpate and readjust
IUPC resting tone Ans ~ 20-25
IUPC resting tone with aminoinfusion Ans ~ should not be above 40,
troubleshoot if this is higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or
recurrent variables Ans ~ amnioinfusion
Auscultation tools Ans ~ intermittent monitoring, use fetoscope or hand
help doppler to trace.
Only true auscultation tool Ans ~ fetoscope, the reason is it is the only
tool that listens to the open and close of the fetal heart valve
Using the doppler or fetoscope Ans ~ count the FHR before, during, and
after a contraction. Document the baseline rate (range), regular vs irregular,
increases or decreases. Do NOT document variability, accels, or decels
doppler category 1 Ans ~ normal FHR baseline, regular rhythm,
presence of increases from FHR baseline, no decreases from baseline
, doppler category 2 Ans ~ includes ANY of the following: irregular
rhythm, presence of FHR decreases, tachycardia, bradycardia (i feel the need
to intervene, I feel like I can't walk out of the room)
doppler category 3 Ans ~ there is none! auscultation because there is
no variabile determination with auscultation
goal of external EFM Ans ~ external monitoring: goal is to detect fetal
heart movement (efm)
Autocorrelation Ans ~ how the monitor adjusts with every third beat
using a mathematical formula, that it is still monitoring this baby. Detected
what is normal for this baby and is making the appropriate adjustments.
What does the FSE measure? Ans ~ Directly monitors R to R ratio (with
scalp lead), definitively measures baby's heartbeat and when the heart is
firing
Narrow R-R interval Ans ~ fetal tachycardia
Prolonged R-R interval Ans ~ fetal bradycardia
FSE contraindications Ans ~ communicable diseases: hepatitis and HIV
Normal uterine activity Ans ~ Normal activity: less than 5 ctx in a 10
minute period averaged over a 30 minutes period (5,5,6 OK but 6,5,6 NOT
OK)
Excessive uterine activity Ans ~ Tachysystole (not hyperstim),
hypertonus (with IUPC resting tone does not go below 20 mmHG-IUPC, 20-
25mmhg shouldn't be higher..if higher usually due to inadequate relation
time), inadequate relaxation time, tetanic contractions(cxn greater than 2
minutes)
What do you do with tachysystole? Ans ~ turn down pitocin (reposition
etc)
Reduce blood flow through the intervillous space Ans ~ Mild
Contractions (30 mmHG)
No blood flow through the intervillous space Ans ~ Moderate
Contractions (50 mmHG)
ANSWERS
Why use fetal monitoring? Ans ~ Primary goal is to prevent fetal and
maternal morbidity and mortality (prevent injury and death to mother and/
or baby), to prevent bad patient outcomes.
What percent of babies who experience a suboptimal event while being fetal
monitored, develop cerebral palsy? Ans ~ 3% of babies with poor tracing
develop cerebral palsy
What are most sentinel events due to? Ans ~ Poor communication
between providers. Most errors are traceable back to communication errors.
Sentinel events Ans ~ bad things that happen to patients due to a
human or equipment error, and not due to the reason that they came into
the hospital (disease process)
Equipment Ans ~ your hands (palpation) use fingertips, ultrasound
transducer, FSE, tocodynamometer, Intrauterine Pressure Catheter,
Auscultation (fetoscope, hand held doppler device).
What if you can not get contractions? Ans ~ palpate and readjust
IUPC resting tone Ans ~ 20-25
IUPC resting tone with aminoinfusion Ans ~ should not be above 40,
troubleshoot if this is higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or
recurrent variables Ans ~ amnioinfusion
Auscultation tools Ans ~ intermittent monitoring, use fetoscope or hand
help doppler to trace.
Only true auscultation tool Ans ~ fetoscope, the reason is it is the only
tool that listens to the open and close of the fetal heart valve
Using the doppler or fetoscope Ans ~ count the FHR before, during, and
after a contraction. Document the baseline rate (range), regular vs irregular,
increases or decreases. Do NOT document variability, accels, or decels
doppler category 1 Ans ~ normal FHR baseline, regular rhythm,
presence of increases from FHR baseline, no decreases from baseline
, doppler category 2 Ans ~ includes ANY of the following: irregular
rhythm, presence of FHR decreases, tachycardia, bradycardia (i feel the need
to intervene, I feel like I can't walk out of the room)
doppler category 3 Ans ~ there is none! auscultation because there is
no variabile determination with auscultation
goal of external EFM Ans ~ external monitoring: goal is to detect fetal
heart movement (efm)
Autocorrelation Ans ~ how the monitor adjusts with every third beat
using a mathematical formula, that it is still monitoring this baby. Detected
what is normal for this baby and is making the appropriate adjustments.
What does the FSE measure? Ans ~ Directly monitors R to R ratio (with
scalp lead), definitively measures baby's heartbeat and when the heart is
firing
Narrow R-R interval Ans ~ fetal tachycardia
Prolonged R-R interval Ans ~ fetal bradycardia
FSE contraindications Ans ~ communicable diseases: hepatitis and HIV
Normal uterine activity Ans ~ Normal activity: less than 5 ctx in a 10
minute period averaged over a 30 minutes period (5,5,6 OK but 6,5,6 NOT
OK)
Excessive uterine activity Ans ~ Tachysystole (not hyperstim),
hypertonus (with IUPC resting tone does not go below 20 mmHG-IUPC, 20-
25mmhg shouldn't be higher..if higher usually due to inadequate relation
time), inadequate relaxation time, tetanic contractions(cxn greater than 2
minutes)
What do you do with tachysystole? Ans ~ turn down pitocin (reposition
etc)
Reduce blood flow through the intervillous space Ans ~ Mild
Contractions (30 mmHG)
No blood flow through the intervillous space Ans ~ Moderate
Contractions (50 mmHG)
