Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:
This tracing demonstrates a normal, reassuring fetal heart pattern that is technically categorized as Category I, indicating normal fetal acid–base status. Before any decision regarding discharge or induction, NCC emphasizes correct assessment of the tracing quality, fetal status, and uterine activity.
Key Tracing Characteristics
Baseline:Approximately 135–145 bpm, well within the normal range of 110–160 bpm.
Variability:The strip shows moderate variability (6–25 bpm), the strongest indicator of adequate fetal oxygenation per NCC, AWHONN, and NICHD.
Accelerations:Several accelerations are present—another reassuring feature of normal fetal well-being.
Decelerations:No variable, late, or prolonged decelerations are present.
Uterine Activity:The lower channel shows poor recording quality and inconsistent signal—suggesting the toco is not capturing contractions well, not that the patient is contracting excessively or not at all.
Correct interpretation per NCC:
NCC emphasizes distinguishing between physiologic assessment and technical artifact.
The fetal tracing is completely reassuring.
The only abnormality is the poor uterine activity signal, a common triage occurrence due to:
Thus, the correct next step is to optimize equipment (reposition the toco, adjust belt, palpate contractions) and continue to monitor.
Why the other options are incorrect:
B. Admit for induction – NOT indicated
There is no evidence of fetal compromise.
No indication for induction is present (pain score 4/10, reassuring FHR, term pregnancy).
NCC emphasizes avoiding unnecessary interventions.
C. Discharge to home – NOT yet appropriate
You cannot safely discharge a patient with a poorly monitored contraction pattern.
Adequate assessment requires confirming uterine activity—after fixing the toco.
Therefore, the appropriate action is:
A. Adjust tocotransducer and continue to monitor.
[References:NCC C-EFM Candidate Guide (2025); NCC Content Outline; AWHONN Fetal Heart Monitoring Principles & Practices; NICHD Definitions; Miller’s Fetal Monitoring Pocket Guide; Menihan Electronic Fetal Monitoring; Simpson & Creehan Perinatal Nursing; Creasy & Resnik Maternal–Fetal Medicine., ]
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