NCC EFM Questions and Answers Already Passed

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NCC EFM Questions and Answers Already Passed 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 Category III: ✔✔• Abnormal fetal acid-base status • Either required • Absent variability with: o Recurrent late decels, or o Recurrent variable decels, or o Bradycardia • Sinusoidal pattern In-Utero resuscitation: ✔✔• Change maternal position • Decrease uterine activity • IV fluid bolus • Correct maternal hypotension • Oxygen administration • Amnioinfusion • Alteration in 2nd stage maternal pushing efforts • If prolapsed cord, then elevate fetal presenting part while moving toward operative birth Baseline FHR: ✔✔• Approximate mean FHR excluding accelerations and decelerations or periods of marked variability (>25 bpm) • Minimum of 2 minutes of identifiable BL segments in any 10 min window • May need to refer to previous 10 min window Baseline variability: ✔✔• Irregular fluctuation in baseline FHR in both amplitude and frequency • Absent- Undetectable • Minimal- 0-5 • Moderate- 6-25 • Marked >25 -> alpha-adrenergic response to decreased uteroplacental blood flow or ephedrine Causes of minimal variability: ✔✔• General anesthesia • Smoking • Quiet sleep • Mag • Acidemia Prolonged acceleration: ✔✔• >=2 min and < 10 min FHR accelerations: ✔✔• >=32- 15x15 • <32- 10x10 Scalp or vibroacoustic stimulation assures a fetal pH of: ✔✔• >=7.19 Recurrent: ✔✔• Occur with >=50% of contractions in any 20 min window Intermittent: ✔✔• Occur with <50% of contractions in any 20 min window Early decel definition: ✔✔• Usually symmetrical gradual decrease (onset to nadir >30 sec) and return to baseline FHR associated with uterine ctx • Nadir occurs at same time as peak of contraction Late decel definition: ✔✔• Usu

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