NCC EFM Exam Breakdown & Study Guide
1. Content on exam: -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
2. Pattern recognition & intervention: -FHR baseline
-FHR variability
-FHR accelerations
-FHR decelerations
-Normal uterine activity
-Abnormal uterine activity
-Fetal dysrhythmias
-Maternal complications
-Uteroplacental complications
-Fetal complications
3. FHR Descriptors: 1) Baseline
2)Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
4. FHR Baseline: Average FHR rounded to nearest 5 during a 10 min
window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be
continuous)
5. Fetal Bradycardia: <110 for e10 min
-Causes: hypotension (ex: after epi), cord prolapse, head
compression, congen- ital defect, rapid descent, abruption or rupture,
tachysystole, post dates, hypo- glycemia, lupus (heart block)
-With “ O2, blood will be shunted to brain, heart, & adrenals,
eventually “ FHR to “ O2 demands of heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate,
evaluate arrhyth- mia, expedite delivery
6. Fetal Tachycardia: >160 for e10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity
,NCC EFM Exam Breakdown & Study Guide
(preterm), SVT, maternal anxiety (catecholamines), dehydration,
hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
, NCC EFM Exam Breakdown & Study Guide
7. FHR Variability: Irregular in amplitude & frequency, quantified by
peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: d5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
8. Minimal variability: d5 bpm but
detectable Sleep, 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)
9. Moderate variability: 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
10.FHR Accelerations: Reliably predicts absence of metabolic
acidemia (spon- taneous or stimulated)
-Onset to peak in <30 sec
-For e32 wks: 15x15 (peak e15 bpm above baseline lasting e15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
11.Early deceleration: Nadir aligns w contraction peak, gradual
onset (e30 secs to nadir), benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
12.Periodic vs Episodic: Periodic: caused by contractions
-recurrent: occurs w e50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
13.Variable deceleration: Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping e15 bpm
lasting 15 secs to <2min
1. Content on exam: -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
2. Pattern recognition & intervention: -FHR baseline
-FHR variability
-FHR accelerations
-FHR decelerations
-Normal uterine activity
-Abnormal uterine activity
-Fetal dysrhythmias
-Maternal complications
-Uteroplacental complications
-Fetal complications
3. FHR Descriptors: 1) Baseline
2)Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
4. FHR Baseline: Average FHR rounded to nearest 5 during a 10 min
window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be
continuous)
5. Fetal Bradycardia: <110 for e10 min
-Causes: hypotension (ex: after epi), cord prolapse, head
compression, congen- ital defect, rapid descent, abruption or rupture,
tachysystole, post dates, hypo- glycemia, lupus (heart block)
-With “ O2, blood will be shunted to brain, heart, & adrenals,
eventually “ FHR to “ O2 demands of heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate,
evaluate arrhyth- mia, expedite delivery
6. Fetal Tachycardia: >160 for e10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity
,NCC EFM Exam Breakdown & Study Guide
(preterm), SVT, maternal anxiety (catecholamines), dehydration,
hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
, NCC EFM Exam Breakdown & Study Guide
7. FHR Variability: Irregular in amplitude & frequency, quantified by
peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: d5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
8. Minimal variability: d5 bpm but
detectable Sleep, 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)
9. Moderate variability: 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
10.FHR Accelerations: Reliably predicts absence of metabolic
acidemia (spon- taneous or stimulated)
-Onset to peak in <30 sec
-For e32 wks: 15x15 (peak e15 bpm above baseline lasting e15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
11.Early deceleration: Nadir aligns w contraction peak, gradual
onset (e30 secs to nadir), benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
12.Periodic vs Episodic: Periodic: caused by contractions
-recurrent: occurs w e50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
13.Variable deceleration: Caused by cord compression
-Interventions: position change, amnioinfusion
-Abrupt onset: <30 seconds from onset to nadir dropping e15 bpm
lasting 15 secs to <2min
