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
(preterm), SVT, maternal anxiety (catecholamines), dehydration,
hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepinephrine)
-Assess mom's temp & infection risk (GBS, PROM)
, 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 lastingc e15 se
-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. 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
(preterm), SVT, maternal anxiety (catecholamines), dehydration,
hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepinephrine)
-Assess mom's temp & infection risk (GBS, PROM)
, 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 lastingc e15 se
-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
