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

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 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 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–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 Exact Extract–Based NCC C-EFM References:

The tracing demonstrates:

Baseline ~150 bpm

Variability ≥ 25 bpm amplitude, highly erratic and wide

No sustained decelerations

No sustained accelerations ≥ 2 min

NICHD/NCC definition of marked variability:

Amplitude of baseline FHR fluctuations greater than 25 bpm.

Marked variability often reflects transient fetal autonomic instability due to:

Fetal stimulation

Mild hypoxemia

Maternal anxiety

Drugs (e.g., butorphanol)

Why other answers are incorrect:

B. Multiple prolonged accelerations — No accelerations of ≥2 minutes are present.

C. Tachycardia with variables — Baseline is NOT tachycardic (>160 bpm), and decelerations are not present.

Thus, the correct interpretation is A. Marked variability.

Comprehensive and Detailed Explanation From Exact Extract (No URLs):

NCC references (AWHONN, Menihan, Simpson, Creasy & Resnik) consistently state that fetal accelerations are a reassuring sign of intact neurologic function. Accelerations represent the interaction of both the sympathetic and parasympathetic branches moderated through the central nervous system, reflecting effective autonomic regulation.

AWHONN specifically describes fetal accelerations as:

• A maturity marker of CNS function,

• Reflecting vigorous fetal movement,

• Demonstrating adequate oxygenation,

• Indicating a well-oxygenated brainstem and cortex.

Simpson & Miller emphasize that accelerations require both systems to be functioning and respond appropriately, which confirms CNS integration, not sympathetic or parasympathetic dominance alone.

Therefore, spontaneous accelerations indicate an integrated CNS response, making Option C the correct NCC-aligned answer.

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Comprehensive and Detailed Explanation (From NCC C-EFM–Referenced Sources)

According to NCC C-EFM content guidance and AWHONN Fetal Heart Monitoring Principles (2022), recurrent variable and late patterns in second stage with descent to +2/+3 station require consideration of expediting delivery, especially when maternal effort is prolonged and oxytocin augmentation is already present.

Menihan & Simpson emphasize that with prolonged second stage, continued pushing beyond 2–3 hours, and vertex at +3 station, the evidence-based next step is operative vaginal birth, provided prerequisites are met. Cesarean is not indicated when the fetal head is already low and deliverable vaginally.

AWHONN and Creasy & Resnik state that increasing oxytocin when facing fetal stress and prolonged second stage is contraindicated, because tachysystole worsens fetal oxygenation and increases risk of fetal compromise.

Exact Extract Concepts Referenced:

– “Expedited delivery is recommended when recurrent decelerations persist in second stage and the head is low enough for operative vaginal birth.” (AWHONN Principles)

– “Oxytocin should be reduced or discontinued in the presence of nonreassuring patterns.” (Simpson, Obstetric Interventions)

– “Operative vaginal delivery is appropriate with full dilation, engaged head, and prolonged second stage.” (Menihan, Simpson; Creasy & Resnik)

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 NCC-Aligned Sources:

This tracing shows:

Baseline ~170–175 bpm → fetal tachycardia

Minimal variability

No contractions of significance

Maternal treatment with magnesium sulfate, which typically decreases baseline and variability—not increase it

NCC and AWHONN physiology guidelines emphasize that fetal tachycardia is most commonly associated with maternal infection, including chorioamnionitis, especially in preterm labor.

Magnesium sulfate does not cause tachycardia; it generally causes:

↓ baseline

↓ variability

Thus, fetal tachycardia + minimal variability in a preterm patient strongly suggests maternal infection, requiring evaluation for chorioamnionitis.

Why the wrong answers are incorrect:

A. Acetaminophen → used after confirming fever, not before evaluating the cause.

B. Discontinuing magnesium → magnesium sulfate does not cause tachycardia; discontinuing it removes fetal neuroprotection.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

Artifact on fetal monitoring:

Appears erratic, disorganized, and without physiologic pattern

Shows random amplitude changes

Often correlates with maternal movement, monitor displacement, or poor signal

Lacks cyclical, repetitive characteristics seen in true dysrhythmias

Fetal dysrhythmias, by contrast:

Have repetitive, patterned, predictable rhythm disturbances

May show uniform premature beats, bigeminy, or sudden rate shifts

Therefore, varied and disorganized = artifact.