Score Higher on Verified EFM | Certified - Electronic Fetal Monitoring Exam Questions with Answers

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:

Contraction duration is defined as the length of time from the beginning of a contraction to the end of the same contraction (NICHD uterine activity definitions).

In the diagram:

Green arrow (B) spans one individual contraction from rise ? peak ? return to baseline.

Blue arrow (A) measures the interval between contractions (frequency).

Red arrow (C) measures peak-to-peak amplitude shape, not duration.

Therefore, the green arrow correctly identifies contraction duration.

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

The tracing clearly shows recurrent deep variable decelerations, characterized by:

Abrupt onset (<30 sec)

Sharp V-shape

Rapid descent and ascent

Depth exceeding 60–70 bpm drops

Occurring with most contractions

This pattern is highly consistent with cord compression, which is the physiologic basis of variable decelerations. According to NCC, NICHD, AWHONN, Miller, and Menihan, recurrent (?50% of contractions) deep variables with slow return to baseline indicate fetal compromise and require targeted intervention.

The patient has already been repositioned, so first-line management has failed. NCC emphasizes that the next recommended intervention for recurrent variable decelerations, particularly when maternal repositioning is ineffective, is amnioinfusion. This intervention relieves cord compression by restoring fluid around the umbilical cord.

Why the other choices are incorrect:

A. Apply a spiral electrode – NOT appropriate

Spiral electrodes improve signal quality but do not treat cord compression.

The tracing is already clearly interpretable, and the issue is physiologic, not technical.

B. Decrease the oxytocin – Not the best next step

Decreasing oxytocin is appropriate when tachysystole is contributing to fetal intolerance.

This strip shows normal contraction frequency (about every 2–3 minutes) and no tachysystole.

Thus, reducing oxytocin alone will not relieve cord compression.

C. Perform an amnioinfusion – CORRECT

NCC-approved references repeatedly state:

For recurrent variable decelerations that persist after maternal repositioning, amnioinfusion is recommended to reduce the frequency and depth of decelerations.

It can improve fetal oxygenation, decrease cord compression, and reduce the need for operative delivery.

It is the intervention most directly targeted to the pathophysiology of this pattern.

Therefore, C. Perform an amnioinfusion is the correct next management step.