1|Page
NCC EFM EXAM Extra Practice Questions and
Answers
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
,2|Page
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
,3|Page
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
, 4|Page
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)
Normal placenta - .....ANSWER ...✔✔ 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
NCC EFM EXAM Extra Practice Questions and
Answers
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
,2|Page
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
,3|Page
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
, 4|Page
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)
Normal placenta - .....ANSWER ...✔✔ 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
