NCC EFM REAL EXAM 200 QUESTIONS AND
DETAIED ANSWERS (VERIFIED ANSWERS)
|AGRADE
Fetal scalp electrode measures - ANSWER R-R waves; still has issues with artifact;
risk of injury, measuring maternal HR in instance of fetal demise; rupture and dilation
required
IUPC - ANSWER solid>fluid filled tips, measures mmHg and allows amnioinfusion;
issue with displacement, perforation, placental abruption
Intermittent auscultation - ANSWER goal is baseline 110-160, +/-accels, no decels; if
present, put on continuous monitor min 20 minutes); cannot determine variability or
types of FHR decels
Active phase auscultation - ANSWER q15 min for high risk up to q30min
Second stage auscultation - ANSWER q5 min if high risk up to q15min
Fetal tolerance of labor - ANSWER auscultate after a contraction x 30-60 seconds;
document rate, rhythm, accels, decels
Doppler vs. fetoscope - ANSWER doppler uses autocorrelation and detects valve
closure; fetoscope listens through opening in heart wall?
Signal ambiguity - ANSWER confusing maternal and fetal heart rate; common with
repositioning, fetal movement, during pushing (maternal tachycardia); can occur even
with fetal demise due to FSE recording maternal blood flow through the placenta
Suspect signal ambiguity - ANSWER when there is lower baseline or >50%
contractions with accelerations (especially with pushing); verify and document maternal
heart rate via pulse oximetry
Halving/doubling - ANSWER Halving occurs if FHR >180-200; may double if rate <50
Extrinsic factors - ANSWER maternal oxygenation, uterine blood flow, placenta
exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of
tissues, FHR regulation
Primary source of oxygen for the feus - ANSWER the maternal respiratory system
, Uterine blood flow - ANSWER 60ml/min non-pregnant vs. 500-1000ml/min; 10-15%
maternal cardiac output
Normal blood flow pathway - ANSWER Blood from maternal vein > intervillous pool of
maternal blood > umbilical vein (oxygenated blood)
Normal placenta - ANSWER Placenta has 15-20 lobules on maternal surface;
Decreased surface area of chorionic villi from abnormal development, infection,
thrombosis, hemorrhage, inflammation (chorio increases risk of CP), degenerative
changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR,
hypoxia, FHR decels
Acute drop in placental function - ANSWER fetal asphyxia
Chronic drop in placental function - ANSWER FGR
O2 and CO2 - ANSWER simple transport (diffusion); electrolytes, fat soluble vitamins,
narcotics, anesthetic gasses, antibiotics
Glucose - ANSWER facilitated transport, by carrier molecules
Active - ANSWER amino acids, calcium, iron, water soluble vitamins (uses ATP)
Umbilical blood flow - ANSWER 2 arteries (deoxygenated) and 1 vein (oxygenation)
Fetal circulation - ANSWER when compromised, fetal blood redistributed to heart,
brain, adrenals; shunting and FHR increase compensate for decreased blood flow and
hypoxemia; limit mixing of oxygenated and deoxygenated blood
Fetal hemoglobin - ANSWER AND increased O2 affinity > adult; fetus has increased
cardiac output and heart rate
Ductus venosus - ANSWER (highest oxygenation) > ductus arteriosus (least
oxygenation);
Abrupt decrease in PO2 leads to - ANSWER 2-3x increase to heart, brain, adrenals;
decrease to gut, spleen, kidneys, limbs
Severe acidemia - ANSWER decrease CO2, BP, and decreased blood flow to brain
and heart > tissue damage, fetal death
Oxygenation depletion cascade - ANSWER aerobic metabolism > hypoxemia > tissue
hypoxia > anaerobic metabolism > lactic acid > metabolic acidosis
FHR regulation - ANSWER Parasympathetic slows, sympathetic speeds FHR
