NCC EFM exam with correct answers

Causes of uteroplacental perfusion decrease: • HTN • Pregnancy • DM • Hypotension • Excessive uterine contractions (hypertonus) • Decreased surface area, edema, degenerative calcifications, infarcts, infection FHR reflects fetal oxygenation from which extrinsic factors: • Maternal oxygenation • Uterine blood flow • Placental change • Umbilical blood flow FHR reflects oxygenation from which intrinsic factors: • Fetal circulation • Oxygenation of tissues • FHR regulation Fetal shunts: • Ductus venosus- liver • PFO- Right to left atria • Ductus arteriosis- pulmonary a. to aorta Oxygen depletion cascade: • Aerobic metabolism • Hypoxemia • Tissue hypoxia • Anaerobic metabolism • Lactic acid build up • Metabolic acidosis Sympathetic innervation: • Releases Eip/norepi • Increases FHR Parasympathetic/Vagal innervation: • Releases ach • Decreases FHR and transmits variability Early decel: • Fetal head compression • -vasovagal response Variable decel: • Cord compression • -increase BP/HTN • -activation of baroreceptor • -decrease FHR, BP, and CO Late decel: • Inadequate uteroplacental blood flow-decreased maternal fetal O2 transfer • -activation of chemoreceptors to respond due to increased PCO2, decreased PO2, and decreased pH • -Fetal bradycardia and hypertension Category I: • Normal fetal acid base status • All the following are required: • Moderate variability • Baseline rate 110-160 • Late or variable decels are absent • Early decels present or absent • Accels present or absent Category II: • Indeterminate compensatory response • Not category I or II