Pass the NCC C-EFM EFM Questions and answers with CertsForce

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

NCC/AWHONN emphasize that the primary goal of intrauterine resuscitation is to:

Optimize uteroplacental blood flow, which restores fetal oxygen delivery.

Key measures include:

Maternal repositioning (lateral)

Reducing tachysystole

IV fluid bolus

Correcting maternal hypotension

Stopping oxytocin

Treating underlying causes

Improving maternal oxygenation is supportive, but improving uteroplacental perfusion is the critical first determinant of resuscitation success.

Why the other answers are not first priority:

A. Oxygen — optional and no longer universally recommended unless maternal hypoxemia exists.

B. Minimizing uterine activity — essential, but still secondary to restoring perfusion.

Correct answer: C. Optimizing uteroplacental blood flow

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

On the tracing:

FHR consistently ranges 170–185 bpm.

Variability remains present, confirming adequate signal.

This pattern persists for the required minimum 10-minute baseline window.

NICHD/NCC define fetal tachycardia as:

Baseline > 160 bpm for at least 10 minutes

Because the FHR is well above 160 for the whole reviewable period, the baseline is tachycardic.

Why the other answers are incorrect:

A. 155 bpm — Too low; FHR visually averages well above this.

B. Indeterminate — Not applicable; variability is clear and the tracing meets the ≥10-minute rule.

Correct answer: C. Tachycardia

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

Post-dates surveillance focuses on:

Amniotic fluid volume (AFI or deepest vertical pocket)

This is the most sensitive parameter of placental function

Oligohydramnios is strongly associated with post-maturity and perinatal morbidity

NCC and AWHONN emphasize amniotic fluid as the primary parameter for fetal well-being in post-term surveillance.

Why the incorrect answers are wrong:

B. Fetal weight → inaccurate and not used for surveillance decisions.

C. Placental calcification → poor predictor of fetal outcome and not used for management.

Comprehensive and Detailed Explanation From Exact Extract (NCC-Referenced Sources)

AWHONN and Menihan clearly state that classification of decelerations is determined by their timing relative to uterine contractions:

Early decelerations: “mirror the contraction; onset, nadir, and recovery occur simultaneously with the contraction.”

Late decelerations: “begin after the contraction begins and return to baseline after the contraction ends.”

Depth is not a differentiating feature, as both early and late decelerations may vary in depth. The onset-to-nadir interval is used to differentiate variable vs. early/late, not early vs. late.

Thus, timing relative to contractions is the correct NCC-supported answer.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

This tracing demonstrates:

A sudden prolonged deceleration following epidural placement

Minimal variability during the deceleration

Event occurring within 15 minutes of epidural

NCC, AWHONN, and Menihan emphasize that maternal hypotension is the most common complication immediately following epidural analgesia. Hypotension leads to:

Reduced uteroplacental perfusion

Fetal bradycardia or prolonged decelerations

Decreased variability during the deceleration

Typical fetal response to maternal hypotension:

Late-like or prolonged deceleration with weakening variability, exactly like the strip shown.

Therefore, the FIRST and most critical step is to check maternal blood pressure.

Other options:

B. Continue to monitor — unsafe when a prolonged deceleration is present.

C. Cervical exam — not indicated; the fetal tracing deterioration is temporally linked to epidural placement.

Thus, the correct action is A. Check maternal blood pressure.

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

NCC-recommended fetal assessment texts emphasize that external Doppler ultrasound may undercount very rapid fetal arrhythmias such as fetal supraventricular tachycardia (SVT). Because Doppler detects mechanical motion rather than electrical activity, the device may record only every other cardiac contraction, a phenomenon known as “half-counting.”

Menihan’s Electronic Fetal Monitoring explains that with SVT—often exceeding 200 to 260 bpm—the monitor “may display a fetal heart rate at approximately half the true atrial rate.” AWHONN teaching materials affirm that rapid, regular tachyarrhythmias may appear deceptively slower on the external monitor due to Doppler under-sampling. Simpson & Creehan note that half-counting is a recognized technical limitation and may cause clinicians to miss true tachyarrhythmias if internal monitoring is not applied.

In contrast, artifact displays irregular, inconsistent, and non-physiologic deflections. Matching the maternal pulse suggests maternal heart rate misinterpretation, not SVT.

Miller’s Pocket Guide also highlights that half-counting is “commonly seen in fetal SVT when using external Doppler due to failure to detect each rapid contraction.”

Therefore, fetal SVT most commonly appears as half the actual rate on an external fetal monitor.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

This tracing shows recurrent late decelerations accompanied by absent variability.

Per NICHD/NCC, a tracing is Category III if ANY of the following are present:

Absent variability AND recurrent late decelerations

Absent variability AND recurrent variable decelerations

Absent variability AND bradycardia

Sinusoidal pattern

In this strip:

Variability is absent

Decelerations are recurrent and late

The determining feature for the classification is absent variability, which indicates significant risk for fetal acidemia.

The contraction pattern (option B) does not determine category.

The deceleration type alone (option C) does not determine Category III without absent variability.

Thus, the classification is Category III because of absent variability.

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:

Toco placement

Maternal body habitus

Positioning

Low contraction intensity in early labor

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.

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

The fetal heart rate tracing shows a normal baseline (120–150 bpm), moderate variability, and no decelerations, consistent with a Category I pattern. According to AWHONN’s Fetal Heart Monitoring Principles & Practices and NCC Perinatal Safety recommendations, a Category I tracing reliably indicates normal fetal acid-base status at the time of assessment and is considered reassuring.

Simpson & Creehan emphasize that in triage, management decisions depend on cervical status, contraction pattern, membrane status, and fetal well-being. With a cervix at 1 cm/50%/-2, intact membranes, and no regular labor pattern, she is not in active or latent labor requiring admission, provided fetal status is reassuring.

Menihan states that a normal tracing lasting two hours with moderate variability supports safe discharge when maternal and fetal assessments are normal. Creasy & Resnik confirm that reassuring fetal testing plus absence of labor is appropriate for outpatient management.

Comprehensive and Detailed Explanation From Exact Extract Without Links:

NCC examination standards and AWHONN clearly state that normal Category I patterns have the highest interobserver agreement because they contain objective, easily identifiable components:

• baseline 110–160 bpm

• moderate variability

• absence of late or variable decelerations

• presence or absence of accelerations

Simpson highlights that Category II tracings have poor reliability due to multiple combinations of variability and decelerations, while Category III patterns have higher agreement but occur far less frequently, limiting reliability measures.

Research cited within NCC-endorsed materials confirms that clinicians demonstrate the greatest agreement in identifying normal Category I patterns, making normal the correct answer.

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