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

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

NCC and AWHONN explain that Contraction Stress Testing (CST):

Has a higher rate of equivocal (“equivocal–suspicious” or “equivocal–hyperstimulation”) results

Frequently must be repeated or replaced with other tests

Requires inducing contractions, which carries risk (hyperstimulation, preterm labor, uterine rupture in scarred uterus)

NST is used more commonly because it is:

Noninvasive

Easier to perform

Has fewer contraindications

Has a lower rate of equivocal results

Why the others are incorrect:

B — CST does detect fetal compromise reliably and is NOT limited in its reporting structure.

C — A negative CST actually has very high negative predictive value for 7 days, making this answer incorrect.

Thus the correct choice is A. Higher frequency of equivocal results.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

Second-stage bradycardia with moderate variability most commonly occurs from:

Vagal stimulation caused by head compression, particularly during descent and pushing.

Moderate variability indicates:

Neurologically intact fetus

Sufficient oxygen reserve

Temporary nature of bradycardia

This aligns with physiologic vagal slowing rather than hypoxic mechanisms.

Why the incorrect answers are wrong:

A. Cord compression → typically produces variable decelerations, not sustained bradycardia with preserved variability.

C. Vasospasm → associated with late decelerations and decreased variability (uteroplacental insufficiency).

Correct answer: B. Vagal stimulation

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

Variability reflects the interplay of the autonomic nervous system—sympathetic and parasympathetic influences—on the fetal myocardium. NCC defines variability as variation in the R–R intervals on the fetal ECG.

Key points:

Variability originates from beat-to-beat fluctuations in ventricular depolarization timing.

These R–R interval changes result from baroreceptor and chemoreceptor responses, vagal modulation, and fetal behavioral states.

Carbon dioxide levels affect chemoreceptors but do not directly define variability.

Thus, variability is best described as resulting from variance in R–R intervals.

Comprehensive and Detailed Explanation From NCC-Aligned Emergency Fetal Response Principles:

Following an eclamptic seizure:

Maternal hypoxia, apnea, and intense sympathetic discharge occur

Uteroplacental perfusion drops

Fetus experiences acute hypoxemia

The expected fetal heart rate response is a prolonged bradycardia

This is well-described in NCC and AWHONN emergency physiology:

“Post-seizure fetal bradycardia is common and often resolves within 5–10 minutes as maternal oxygenation stabilizes.”

Why other answers are incorrect:

B. Sinusoidal pattern — Rare and usually indicates fetal anemia, not post-seizure status.

C. Variable decelerations — Associated with cord compression, not seizures.

Correct answer: A. Bradycardia

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

The fetal heart rate tracing shows:

Baseline around 140 bpm

Minimal variability

No accelerations

No decelerations

Regular uterine activity but not tachysystole

This pattern is Category II, but in the context of:

28-week gestation

Immediate postoperative status after anesthesia

Maternal alertness and stability

NCC and AWHONN emphasize that maternal sedation, post-anesthesia effects, medications, and physiologic stress commonly cause temporary minimal variability without acidemia, especially at preterm gestations where baseline variability is normally lower.

Key NCC principle:

Minimal variability in a stable mother without decelerations does NOT require emergent delivery.

Instead, the fetus should be observed as anesthesia effects wear off.

Why other answers are incorrect:

A. Terbutaline – No tachysystole and no recurrent decels are present.

C. Cesarean birth – No bradycardia, no late decels, no absent variability, and no Category III criteria.

Thus, appropriate management is B. Continued monitoring.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

Because the fetal myocardium is immature, it has:

Limited ability to increase stroke volume

Limited ability to increase contractility

Therefore, fetal cardiac output (CO) is almost entirely dependent on heart rate.

NCC and AWHONN physiology describe:

CO = stroke volume × heart rate

In the fetus, stroke volume is relatively fixed

Therefore, changes in HR directly affect cardiac output

Tachycardia → increases CO

Bradycardia → decreases CO → decreased perfusion and oxygen delivery

Why the other options are incorrect:

A. Activity does not fundamentally determine CO.

B. Baroreceptors regulate HR reflexively but are not the primary determinant of cardiac output.

Correct answer: C. Heart rate

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

NCC and AWHONN physiology teachings:

Variable decelerations caused by cord compression lead to:

Transient interruption of umbilical venous flow

Impaired fetal gas exchange

Acute rise in CO₂

Respiratory acidosis (early phase of hypoxemia)

This is well documented:

Early decelerations → head compression → NOT associated with acidemia.

Late decelerations → uteroplacental insufficiency → metabolic acidosis, not respiratory.

Thus:

Variable decelerations → respiratory acidosis

Late decelerations → metabolic acidosis

Correct answer: C. Variable