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

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

The tracing demonstrates:

Baseline: approx. 140 bpm

Variability: minimal-to-moderate (fluctuating but not consistently moderate)

Decelerations: shallow variable decelerations

Accelerations: not consistently present

According to NICHD/NCC definitions:

Category I requires ALL of the following:

Baseline 110–160

Moderate variability

No late or variable decelerations

Early decels and accelerations may be present

This tracing does not have consistently moderate variability and does have variable decelerations, so it is not Category I.

Category III requires ANY of the following:

Absent variability with recurrent late decels

Absent variability with recurrent variable decels

Absent variability with bradycardia

Sinusoidal pattern

This tracing does not show absent variability, bradycardia, or recurrent significant lates.

Category II includes:

Minimal variability

Absence of accelerations

Variable decelerations

Tracings not clearly Category I or III

This strip fits Category II exactly due to minimal variability + intermittent variable decelerations.

Thus, the correct classification is Category II.

Comprehensive and Detailed Explanation From NCC-Aligned BPP Management Standards:

NCC, AWHONN, and maternal-fetal medicine guidelines state:

A BPP score of 4/10 at term is abnormal.

A low score indicates hypoxia-related CNS suppression.

Oligohydramnios is an additional high-risk finding, especially in hypertension.

At ≥ 37 weeks, a BPP score of ≤ 4/10 warrants immediate delivery.

Repeating the test is acceptable at preterm gestations (e.g., < 32–34 weeks), but not at 38 weeks.

Why the other answers are incorrect:

B. Discharge home — Contraindicated with abnormal BPP.

C. Repeat in 24 hours — Not recommended at term with a score of 4.

Correct answer: A. Admit for delivery

Comprehensive and Detailed Explanation From NCC-Aligned Physiologic Sources:

Oxygen transfer occurs at the maternal–fetal interface within the intervillous space, where:

Maternal blood from the spiral arteries bathes the chorionic villi

Diffusion occurs between maternal blood and fetal capillary beds

Oxygen then travels through fetal circulation via the umbilical vein

Thus:

Intervillous space = site of gas exchange

Spiral arteries = deliver maternal blood to that space

Umbilical vein = fetal vessel carrying oxygenated blood after exchange has occurred

Correct answer: A. Intervillous space

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

NCC’s Professional Issues domain emphasizes communication, collaboration, and team-based interpretation of electronic fetal monitoring tracings.

For non-emergent differences in interpretation, the first step is:

Discussion and joint review of the tracing by the involved clinicians.

Only if disagreement persists should the chain of command be used. Documentation occurs after consensus or escalation—not as the first step.

Thus, the appropriate first step is C. Have the involved clinicians review the tracing together.

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

Assessment of likely fetal acid–base status is grounded in NCC-aligned principles that correlate fetal pH with fetal heart rate patterns, especially variability, presence/absence of accelerations, and type and depth of decelerations.

This tracing shows the following features:

Baseline:

The fetal heart rate baseline is approximately 140–150 bpm, within the normal 110–160 bpm range.

Variability:

Moderate variability is present—approximately 6–25 bpm amplitude.

Per NCC and NICHD definitions, moderate variability is strongly associated with normal fetal oxygenation and normal fetal pH > 7.20–7.25.

Accelerations:

There are occasional small accelerations, another strong indicator of normal fetal acid–base status.

Decelerations:

The tracing shows occasional variable decelerations, shallow and brief, recovering rapidly, typical of intermittent cord compression.

NCC references emphasize that intermittent, non-recurrent variables with moderate variability do not correlate with acidemia.

Uterine activity:

Contractions are present but not excessive, and fetal response remains reassuring.

Correlating tracing features with fetal pH (per NCC, AWHONN, Simpson, Menihan):

Moderate variability is the strongest intrapartum indicator of normal fetal pH.

The NICHD/NCC consensus repeatedly states that:

“The presence of moderate variability reliably predicts adequate fetal oxygenation and a fetal pH above the threshold associated with metabolic acidemia.”

Fetal pH below 7.15 is associated with:

Absent variability

Recurrent late decelerations

Recurrent deep variable decelerations

Prolonged bradycardia

None are present in this tracing.

Because the tracing demonstrates moderate variability, intermittent uncomplicated variables, and no recurrent late decelerations, the physiologic expectation is that the fetal pH remains normal, significantly above 7.15.

Therefore, the correct answer is: A (above 7.15).

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

NCC and NICHD differentiate:

Periodic decelerations – those occurring with contractions

Episodic decelerations – those occurring independent of contractions

Deceleration types:

Early – periodic (mirror contractions)

Late – periodic (after peak of contraction)

Variable – may be periodic or episodic, and are the only type strongly associated with episodic patterns**

Therefore, the only deceleration type that is characteristically episodic is a variable deceleration.

Correct answer: C. Variable deceleration

Comprehensive and Detailed Explanation From Exact Extract Without Links:

NCC and AWHONN teaching materials describe that butorphanol, an opioid analgesic, characteristically produces a transient sinusoidal-like pattern or pseudo-sinusoidal pattern with moderate variability preserved.

This drug-related pattern has:

• smooth, regular oscillations

• maintained variability

• absence of true periodic decelerations

• resolution within 20–60 minutes

Simpson & Menihan describe butorphanol as producing a “saw-tooth, wavering pattern” often mistaken for dysrhythmia but actually benign.

True sinusoidal patterns (e.g., fetal-maternal hemorrhage) are fixed, smooth, non-variable patterns with absent variability, not matching the scenario.

Atrial flutter produces very rapid atrial contractions, which manifest as irregular baseline spikes—also not consistent.

Therefore, the described tracing aligns most closely with butorphanol effects.

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

Sustained fetal supraventricular tachycardia (SVT) often produces heart rates > 200–240 bpm, causing:

Poor ventricular filling

Decreased stroke volume

Reduced cardiac output

Congestive heart failure

Progressive fluid accumulation

NCC and AWHONN emphasize that untreated SVT leads to hydrops fetalis, characterized by:

Ascites

Pleural effusion

Pericardial effusion

Skin edema

Why the other answers are incorrect:

A. Fetal anemia — Causes tachycardia but is not caused by SVT.

C. Neonatal pacemaker — Pacemakers treat heart block, not SVT.

Correct answer: B. Hydrops fetalis

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

NCC-recommended physiology references (AWHONN, Simpson & Creehan, Menihan, Creasy & Resnik) consistently state that the primary mechanism by which tachysystole affects fetal oxygenation is reduced uteroplacental perfusion, specifically through impaired intervillous space reperfusion.

During a normal contraction cycle, the fetus receives oxygen between contractions, when the uterus relaxes and maternal blood re-enters the intervillous space. AWHONN’s Fetal Heart Monitoring Principles & Practices explains that tachysystole—defined as more than five contractions in 10 minutes averaged over 30 minutes—shortens or eliminates the relaxation phase, preventing adequate placental reoxygenation.

Simpson & Creehan highlight that “tachysystole decreases uteroplacental blood flow and interferes with replenishment of oxygenated maternal blood in the intervillous space.” Menihan emphasizes that fetal hypoxemia in tachysystole results from interrupted perfusion, not from altered oxygen transport or maternal hemodynamic changes. Creasy & Resnik confirm that uterine overactivity reduces intervillous perfusion during contractions and impairs fetal oxygen exchange.

Thus, the physiologic problem is failure of the intervillous space to reperfuse, which compromises fetal oxygenation.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

A prolonged deceleration is defined by NICHD and NCC as:

A deceleration lasting ≥2 minutes but <10 minutes

Decrease in FHR of ≥15 bpm

Can occur with or without uterine contractions

This tracing shows:

A deep drop in FHR down to ~60–70 bpm

Duration lasting several minutes

Recovery back to baseline

Moderate variability present afterward

Because variability remains present and the tracing does not show:

Absent variability

Recurrent late decelerations

Recurrent variable decelerations with absent variability

Bradycardia for ≥10 minutes

…it does not meet criteria for Category III.

It is also not bradycardia, because bradycardia requires:

Baseline <110 bpm for 10 minutes or longer

Therefore the correct interpretation is a prolonged deceleration.