EFM Exam Dumps - Certified - Electronic Fetal Monitoring

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

This tracing shows:

Baseline ~145 bpm

Minimal variability

No accelerations or decelerations

Very little fluctuation → resembles a flat/minimal variability Category II tracing

The key physiologic mechanism behind minimal variability in the presence of a normal baseline and normal contraction pattern is most often:

Increased fetal sympathetic tone, driven by catecholamine release (epinephrine and norepinephrine).

NCC and AWHONN explain:

Catecholamine release (due to fetal stress, early hypoxemia, or maternal stress) results in:

Reduced beat-to-beat fluctuation

Minimal baseline variability

This is considered an early compensatory mechanism, not yet a decompensated hypoxic state.

Why the other answers are incorrect:

A. Myocardial hypoxic depression

Causes absent variability, NOT minimal variability.

Represents advanced or severe hypoxia. The FHR here is not absent variability.

C. Vagal stimulation in response to hypoxemia

Produces decelerations, especially late or prolonged.

This strip shows no decelerations, ruling this out.

Therefore the most accurate physiologic explanation is B. Release of catecholamines.

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 NCC-Aligned Sources:

Because the fetal myocardium is immature, it has:

Limited ability to increase stroke volume

Limited ability to increase contractility

Therefore, fetal cardiac output (CO) is almost entirely dependent on heart rate.

NCC and AWHONN physiology describe:

CO = stroke volume × heart rate

In the fetus, stroke volume is relatively fixed

Therefore, changes in HR directly affect cardiac output

Tachycardia → increases CO

Bradycardia → decreases CO → decreased perfusion and oxygen delivery

Why the other options are incorrect:

A. Activity does not fundamentally determine CO.

B. Baroreceptors regulate HR reflexively but are not the primary determinant of cardiac output.

Correct answer: C. Heart rate

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

A wandering baseline is:

A slow, fluctuating baseline

Low amplitude

No variability

No accelerations

Indicative of severe fetal neurologic injury and terminal fetal status

NCC and AWHONN describe wandering baseline as a preterminal pattern.

Why the other answers are wrong:

A. Marked variability → often transient and not associated with demise.

B. Recurrent lates → concerning but not a neurological-injury pattern unless variability absent.

Correct answer: C. Wandering baseline.

Comprehensive and Detailed Explanation From Exact Extract Sources:

In fetal physiology, the highest oxygen saturation exists in the umbilical vein, which then flows through the ductus venosus before entering the right atrium.

According to Creasy & Resnik Maternal-Fetal Medicine, and AWHONN physiologic foundations:

The umbilical vein carries oxygen-rich blood from the placenta (approx. 80% saturation).

Most of this blood bypasses the liver via the ductus venosus, which therefore contains the most highly oxygenated blood within the fetal circulatory system.

By contrast:

The descending aorta contains mixed blood with significantly lower oxygen content due to mixing after passage through the ductus arteriosus.

The pulmonary arteries in the fetus carry predominantly deoxygenated blood, since fetal lungs are fluid-filled and have high pulmonary vascular resistance.

Thus, the structure containing the highest fetal oxygen concentration is the ductus venosus.

Comprehensive and Detailed Explanation From Exact Extract (NCC C-EFM sources: AWHONN, Miller’s Pocket Guide, Menihan, Simpson, Creasy & Resnik, 2025 Candidate Guide)

The tracing displays baseline fetal bradycardia, with a rate near 100 bpm, minimal variability, and preserved periodic response. According to AWHONN’s Fetal Heart Monitoring Principles & Practices and Menihan’s Electronic Fetal Monitoring, maternal conditions that reduce oxygen-carrying capacity—including maternal anemia—can lead to lower fetal oxygen delivery, prompting a fetal compensatory bradycardic baseline.

Creasy & Resnik’s Maternal-Fetal Medicine notes that sickle cell anemia decreases maternal hemoglobin function even when maternal vital signs appear stable, reducing uteroplacental oxygen transport. Fetuses of mothers with sickling disorders may demonstrate lower resting fetal heart rates due to chronic mild hypoxemia.

Conversely, Eisenmenger’s syndrome is associated with severe maternal cyanosis and high fetal mortality, often producing late decelerations and growth restriction rather than mild bradycardia. Systemic lupus erythematosus (SLE) is commonly associated with heart block (especially with anti-Ro/SSA antibodies), which is not displayed here, as true heart block presents with a fixed atrial–ventricular dissociation and FHR < 60 bpm.

Thus, based on fetal physiology and maternal disease correlations taught in NCC-recommended sources, the tracing is most consistent with maternal sickle cell anemia.

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

Whenever a fetal heart rate is unexpectedly low (such as 90 bpm), the FIRST step per NCC and AWHONN is to confirm that the signal is fetal, not maternal.

Even internal spiral electrodes can capture maternal heart rate, especially after:

Rupture of membranes

Maternal hypotension

Maternal dehydration

Maternal tachycardia or bradycardia

Thus, the first, most immediate action is:

→ Palpate the maternal radial pulse to determine whether the tracing is maternal or fetal.

If rates match → the monitor is falsely detecting the maternal pulse.

If rates differ → confirm true fetal bradycardia and begin intrauterine resuscitation.

Why the other options are incorrect:

A. Intrauterine resuscitation — should NOT begin before confirming the tracing is fetal.

C. Bedside ultrasound — appropriate after confirming that the tracing is not maternal, not before.

Correct answer: B. Palpation of the maternal radial pulse.