,EFM Certification Study Guide 2025 | 400+
Real Q&A + Clinical Scenarios | NCC Exam Prep
(Graded A+)/ 2025 NCC EFM Exam Prep |
Verified Questions & Answers | A+ Study
Guide for Nurses & Midwives.
Polyhydramnios
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
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
US transducer, depicts valve closure; uses autocorrelation
Autocorrelation
successive US waveforms at many points; current technology which is more accurate at detecting FHR
variability; controls artifact sound waves
Toco/tocotransducer
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
R-R waves; still has issues with artifact; risk of injury, measuring maternal HR in instance of fetal demise;
rupture and dilation required
IUPC
solid>fluid filled tips, measures mmHg and allows amnioinfusion; issue with displacement, perforation,
placental abruption
Intermittent auscultation
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
, q15 min for high risk up to q30min
Second stage auscultation
q5 min if high risk up to q15min
Fetal tolerance of labor
auscultate after a contraction x 30-60 seconds; document rate, rhythm, accels, decels
Doppler vs. fetoscope
doppler uses autocorrelation and detects valve closure; fetoscope listens through opening in heart wall?
Signal ambiguity
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
when there is lower baseline or >50% contractions with accelerations (especially with pushing); verify
and document maternal heart rate via pulse oximetry
Halving/doubling
Halving occurs if FHR >180-200; may double if rate <50
Extrinsic factors
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
the maternal respiratory system
Uterine blood flow
60ml/min non-pregnant vs. 500-1000ml/min; 10-15% maternal cardiac output
Normal blood flow pathway
Blood from maternal vein > intervillous pool of maternal blood > umbilical vein (oxygenated blood)
Normal placenta
Placenta has 15-20 lobules on maternal surface; Decreased surface area of chorionic villi from abnormal
development, infection, thrombosis, hemorrhage, inflammation (chorio increases risk of CP),
degenerative changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR,
hypoxia, FHR decels
Acute drop in placental function
Real Q&A + Clinical Scenarios | NCC Exam Prep
(Graded A+)/ 2025 NCC EFM Exam Prep |
Verified Questions & Answers | A+ Study
Guide for Nurses & Midwives.
Polyhydramnios
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
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
US transducer, depicts valve closure; uses autocorrelation
Autocorrelation
successive US waveforms at many points; current technology which is more accurate at detecting FHR
variability; controls artifact sound waves
Toco/tocotransducer
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
R-R waves; still has issues with artifact; risk of injury, measuring maternal HR in instance of fetal demise;
rupture and dilation required
IUPC
solid>fluid filled tips, measures mmHg and allows amnioinfusion; issue with displacement, perforation,
placental abruption
Intermittent auscultation
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
, q15 min for high risk up to q30min
Second stage auscultation
q5 min if high risk up to q15min
Fetal tolerance of labor
auscultate after a contraction x 30-60 seconds; document rate, rhythm, accels, decels
Doppler vs. fetoscope
doppler uses autocorrelation and detects valve closure; fetoscope listens through opening in heart wall?
Signal ambiguity
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
when there is lower baseline or >50% contractions with accelerations (especially with pushing); verify
and document maternal heart rate via pulse oximetry
Halving/doubling
Halving occurs if FHR >180-200; may double if rate <50
Extrinsic factors
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
the maternal respiratory system
Uterine blood flow
60ml/min non-pregnant vs. 500-1000ml/min; 10-15% maternal cardiac output
Normal blood flow pathway
Blood from maternal vein > intervillous pool of maternal blood > umbilical vein (oxygenated blood)
Normal placenta
Placenta has 15-20 lobules on maternal surface; Decreased surface area of chorionic villi from abnormal
development, infection, thrombosis, hemorrhage, inflammation (chorio increases risk of CP),
degenerative changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR,
hypoxia, FHR decels
Acute drop in placental function
