NCC EFM EXAM LATEST UPDATE 2023-
2024 QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Polyhydramnios - ANSWER-single MVP > 8 cm or AFI >24; 1% of pregnancies; 60%
idiopathic; multiple gestation, maternal diabetes, hydrops, anomalies, TORCH;
ass'd with cardiac/GI issues/renal issues
Oligohydramnios - ANSWER-single MVP < 2 cm or AFI < 5 at term (less than
5%ile); associated with FGR, placental abnormalities, urinary tract abnormalities,
post-term pregnancies, ruptured or idiopathic membranes
Doppler - ANSWER-US transducer, depicts valve closure; uses autocorrelation
Autocorrelation - ANSWER-successive US waveforms at many points; current
technology which is more accurate at detecting FHR variability; controls artifact
sound waves
,Toco/tocotransducer - ANSWER-detects change in contour with contractions;
place at fundus or at area of maximum palpation; difficult to measure with
obesity, polyhydramnios
Fetal scalp electrode measures - ANSWER-R-R waves; still has issues with artifact;
risk of injury, measuring maternal HR in instance of fetal demise; rupture and
dilation required
IUPC - ANSWER-solid>fluid filled tips, measures mmHg and allows amnioinfusion;
issue with displacement, perforation, placental abruption
Intermittent auscultation - ANSWER-goal is baseline 110-160, +/-accels, no decels;
if present, put on continuous monitor min 20 minutes); cannot determine
variability or types of FHR decels
Active phase auscultation - ANSWER-q15 min for high risk up to q30min
Second stage auscultation - ANSWER-q5 min if high risk up to q15min
Fetal tolerance of labor - ANSWER-auscultate after a contraction x 30-60 seconds;
document rate, rhythm, accels, decels
Doppler vs. fetoscope - ANSWER-doppler uses autocorrelation and detects valve
closure; fetoscope listens through opening in heart wall?
, Signal ambiguity - ANSWER-confusing maternal and fetal heart rate; common with
repositioning, fetal movement, during pushing (maternal tachycardia); can occur
even with fetal demise due to FSE recording maternal blood flow through the
placenta
Suspect signal ambiguity - ANSWER-when there is lower baseline or >50%
contractions with accelerations (especially with pushing); verify and document
maternal heart rate via pulse oximetry
Halving/doubling - ANSWER-Halving occurs if FHR >180-200; may double if rate
<50
Extrinsic factors - ANSWER-maternal oxygenation, uterine blood flow, placenta
exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of
tissues, FHR regulation
Primary source of oxygen for the feus - ANSWER-the maternal respiratory system
Uterine blood flow - ANSWER-60ml/min non-pregnant vs. 500-1000ml/min; 10-
15% maternal cardiac output
Normal blood flow pathway - ANSWER-Blood from maternal vein > intervillous
pool of maternal blood > umbilical vein (oxygenated blood)
2024 QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Polyhydramnios - ANSWER-single MVP > 8 cm or AFI >24; 1% of pregnancies; 60%
idiopathic; multiple gestation, maternal diabetes, hydrops, anomalies, TORCH;
ass'd with cardiac/GI issues/renal issues
Oligohydramnios - ANSWER-single MVP < 2 cm or AFI < 5 at term (less than
5%ile); associated with FGR, placental abnormalities, urinary tract abnormalities,
post-term pregnancies, ruptured or idiopathic membranes
Doppler - ANSWER-US transducer, depicts valve closure; uses autocorrelation
Autocorrelation - ANSWER-successive US waveforms at many points; current
technology which is more accurate at detecting FHR variability; controls artifact
sound waves
,Toco/tocotransducer - ANSWER-detects change in contour with contractions;
place at fundus or at area of maximum palpation; difficult to measure with
obesity, polyhydramnios
Fetal scalp electrode measures - ANSWER-R-R waves; still has issues with artifact;
risk of injury, measuring maternal HR in instance of fetal demise; rupture and
dilation required
IUPC - ANSWER-solid>fluid filled tips, measures mmHg and allows amnioinfusion;
issue with displacement, perforation, placental abruption
Intermittent auscultation - ANSWER-goal is baseline 110-160, +/-accels, no decels;
if present, put on continuous monitor min 20 minutes); cannot determine
variability or types of FHR decels
Active phase auscultation - ANSWER-q15 min for high risk up to q30min
Second stage auscultation - ANSWER-q5 min if high risk up to q15min
Fetal tolerance of labor - ANSWER-auscultate after a contraction x 30-60 seconds;
document rate, rhythm, accels, decels
Doppler vs. fetoscope - ANSWER-doppler uses autocorrelation and detects valve
closure; fetoscope listens through opening in heart wall?
, Signal ambiguity - ANSWER-confusing maternal and fetal heart rate; common with
repositioning, fetal movement, during pushing (maternal tachycardia); can occur
even with fetal demise due to FSE recording maternal blood flow through the
placenta
Suspect signal ambiguity - ANSWER-when there is lower baseline or >50%
contractions with accelerations (especially with pushing); verify and document
maternal heart rate via pulse oximetry
Halving/doubling - ANSWER-Halving occurs if FHR >180-200; may double if rate
<50
Extrinsic factors - ANSWER-maternal oxygenation, uterine blood flow, placenta
exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of
tissues, FHR regulation
Primary source of oxygen for the feus - ANSWER-the maternal respiratory system
Uterine blood flow - ANSWER-60ml/min non-pregnant vs. 500-1000ml/min; 10-
15% maternal cardiac output
Normal blood flow pathway - ANSWER-Blood from maternal vein > intervillous
pool of maternal blood > umbilical vein (oxygenated blood)
