NCC EFM - Certified - Electronic Fetal Monitoring

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

Oxygen saturation refers to the percentage of hemoglobin binding sites occupied by oxygen. NCC physiology resources, including Simpson & Creehan and Creasy & Resnik, define oxygen saturation as the “ratio of oxyhemoglobin to total hemoglobin”—the same definition used in fetal oxygenation discussions.

Oxygen affinity refers to hemoglobin’s tendency to bind oxygen (related to the oxyhemoglobin dissociation curve).

Oxygen carrying capacity refers to the total amount of oxygen hemoglobin can transport, independent of current saturation.

AWHONN and Menihan emphasize that fetal oxygenation assessment is dependent on understanding oxygen saturation, not affinity or carrying capacity, when discussing fetal hypoxemia and gas exchange.

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:

This tracing shows recurrent late decelerations accompanied by absent variability.

Per NICHD/NCC, a tracing is Category III if ANY of the following are present:

Absent variability AND recurrent late decelerations

Absent variability AND recurrent variable decelerations

Absent variability AND bradycardia

Sinusoidal pattern

In this strip:

Variability is absent

Decelerations are recurrent and late

The determining feature for the classification is absent variability, which indicates significant risk for fetal acidemia.

The contraction pattern (option B) does not determine category.

The deceleration type alone (option C) does not determine Category III without absent variability.

Thus, the classification is Category III because of absent variability.

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

NCC emphasizes that only objective acid-base assessment can diagnose intrapartum asphyxia. This is accomplished with cord arterial blood gas analysis showing:

pH < 7.0–7.1

Base deficit ≥ 12 mmol/L

Elevated PCOâ‚‚

FHR patterns suggest risk, but do not diagnose asphyxia.

Apgar scores, especially at 1 minute, do not correlate reliably with acidemia.

Thus, cord gas analysis is the correct determinant.

Comprehensive and Detailed Explanation From Exact Extract (NCC-Referenced Sources)

According to AWHONN, Simpson, and NCC C-EFM physiologic competencies, uterine rupture commonly presents with:

Sudden prolonged deceleration

Recurrent variables

Fetal bradycardia

Possible loss of station, vaginal bleeding, maternal pain

AWHONN specifically lists:

“Prolonged deceleration is the most common initial fetal sign of uterine rupture.”

Absent variability can occur later, but it is not the most common initial pattern.

“Loss of uterine pressure” refers to loss of toco signal, not a fetal heart rate characteristic.

Therefore, NCC-validated interpretation: prolonged and variable decelerations.

Comprehensive and Detailed Explanation From Exact Extract Without Any URLs or Links:

NCC references (AWHONN, Simpson, Menihan) and the Physiology domain emphasize that baseline fetal heart rate is higher at earlier gestational ages due to predominant sympathetic tone and immature parasympathetic modulation. For a 28-week fetus, a baseline between 150–170 bpm may fall within the upper normal/mild tachycardic range.

Before classifying fetal tachycardia, recommended by AWHONN and Simpson, clinicians must first assess maternal contributors:

Fever

Tachycardia

Infection

Dehydration

Medications (e.g., beta-agonists)

Anxiety

This matches NCC’s required first-line action: evaluate maternal status before escalating fetal assessment.

A biophysical profile (BPP) is not the immediate next step unless maternal status and fetal environment do not explain the finding. Continuing observation without maternal evaluation is contrary to perinatal safety standards.

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

AWHONN and NICHD definitions state that fetal accelerations are a strong indicator of adequate fetal oxygenation and neurologic integrity. Accelerations reflect intact sympathetic and parasympathetic balance and adequate oxygen reserve.

Simpson & Creehan emphasize accelerations as “the most reliable sign of fetal well-being,” because they require intact autonomic function, sufficient pH, and adequate oxygenation. Menihan also identifies accelerations as the most reassuring feature on a fetal heart tracing.

Fetal movement is helpful but not directly reflective of oxygenation, as movements can decline for non-hypoxic reasons (sleep cycles, maternal sedation). Regular sleep–wake cycles are normal developmental neurologic patterns and not oxygenation markers.

Creasy & Resnik reinforce that “presence of accelerations reliably indicates absence of metabolic acidemia.”

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

NCC and AWHONN physiology teachings:

Variable decelerations caused by cord compression lead to:

Transient interruption of umbilical venous flow

Impaired fetal gas exchange

Acute rise in COâ‚‚

Respiratory acidosis (early phase of hypoxemia)

This is well documented:

Early decelerations → head compression → NOT associated with acidemia.

Late decelerations → uteroplacental insufficiency → metabolic acidosis, not respiratory.

Thus:

Variable decelerations → respiratory acidosis

Late decelerations → metabolic acidosis

Correct answer: C. Variable

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

The fetal heart rate tracing shows:

Baseline around 140 bpm

Minimal variability

No accelerations

No decelerations

Regular uterine activity but not tachysystole

This pattern is Category II, but in the context of:

28-week gestation

Immediate postoperative status after anesthesia

Maternal alertness and stability

NCC and AWHONN emphasize that maternal sedation, post-anesthesia effects, medications, and physiologic stress commonly cause temporary minimal variability without acidemia, especially at preterm gestations where baseline variability is normally lower.

Key NCC principle:

Minimal variability in a stable mother without decelerations does NOT require emergent delivery.

Instead, the fetus should be observed as anesthesia effects wear off.

Why other answers are incorrect:

A. Terbutaline – No tachysystole and no recurrent decels are present.

C. Cesarean birth – No bradycardia, no late decels, no absent variability, and no Category III criteria.

Thus, appropriate management is B. Continued monitoring.