NCC EFM Exam Breakdown and Study
Guide 100% Verified
Content on exam - Correct Answers -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Correct Answers -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors - Correct Answers 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline - Correct Answers 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)
Fetal Bradycardia - Correct Answers <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital
defect, rapid descent, abruption or rupture, tachysystole, post dates, hypoglycemia,
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 arrhythmia,
expedite delivery
Fetal Tachycardia - Correct Answers >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)
FHR Variability - Correct Answers 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: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability - Correct Answers ≤5 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)
Moderate variability - Correct Answers 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations - Correct Answers 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)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration - Correct Answers Nadir aligns w contraction peak, gradual onset
(≥30 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
Periodic vs Episodic - Correct Answers Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
Variable deceleration - Correct Answers Caused by cord compression
-Interventions: position change, amnioinfusion
Guide 100% Verified
Content on exam - Correct Answers -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Correct Answers -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors - Correct Answers 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline - Correct Answers 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)
Fetal Bradycardia - Correct Answers <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital
defect, rapid descent, abruption or rupture, tachysystole, post dates, hypoglycemia,
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 arrhythmia,
expedite delivery
Fetal Tachycardia - Correct Answers >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)
FHR Variability - Correct Answers 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: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability - Correct Answers ≤5 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)
Moderate variability - Correct Answers 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations - Correct Answers 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)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration - Correct Answers Nadir aligns w contraction peak, gradual onset
(≥30 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
Periodic vs Episodic - Correct Answers Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
Episodic: spontaneous
Variable deceleration - Correct Answers Caused by cord compression
-Interventions: position change, amnioinfusion
