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Electronic Fetal Monitoring Practice Test

C-EFM test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Domain 1: ELECTRONIC MONITORING EQUIPMENT

- Fetal Heart Rate Monitoring
- Ultrasonic Transducer
- Doppler Effect
- Fetal Scalp Electrode
- Signal Ambiguity
- Autocorrelation

- Uterine Monitoring
- Tocotransducer
- Intrauterine Pressure Catheter
- Montevideo Units
- Uterine Tone

- Equipment Failure and Troubleshooting
- Signal Loss
- Artifact Recognition
- Paper Speed (3 cm/min)
- Maternal Heart Rate Interference

Domain 2: PHYSIOLOGY

- Uteroplacental Physiology
- Placental Exchange
- Intervillous Space
- Uterine Blood Flow
- Spiral Arteries

- Factors Affecting Fetal Oxygenation
- Maternal Hypoxia
- Uteroplacental Insufficiency
- Fetal Acid-Base Balance
- Neuromodulation
- Vagus Nerve Stimulation

Domain 3: PATTERN RECOGNITION AND INTERVENTION

- Fetal Baseline Heart Rate
- Baseline Rate (110-160 bpm)
- Sinusoidal Pattern
- Baseline Variability

- Fetal Heart Rate Variability
- Absent Variability
- Minimal Variability
- Moderate Variability
- Marked Variability

- Abnormal Uterine Activity
- Tachysystole
- Hypertonus
- Uterine Rupture
- Couvelaire Uterus

- Fetal Dysrhythmias
- Arrhythmias
- Premature Atrial Contractions
- Supraventricular Tachycardia

- Maternal Complications
- Preeclampsia
- Epidural Anesthesia
- Hypotension
- Diabetes

- Uteroplacental Complications
- Placental Abruption
- Placenta Previa
- Oligohydramnios
- Vasa Previa

- Fetal Complications- Normal Uterine Activity
- Contraction Frequency
- Contraction Duration
- Contraction Intensity
- Resting Tone
- Intrauterine Growth Restriction
- Fetal Anemia
- Meconium Aspiration
- Non-Reassuring Fetal Status

- Fetal Heart Rate Accelerations
- Acceleration Criteria
- Variable Decelerations
- Prolonged Decelerations
- Late Decelerations

Domain 4: FETAL ASSESSMENT METHODS

- Auscultation
- Intermittent Auscultation
- Leopold Maneuvers
- Fetal Position

- Fetal Movement and Stimulation
- Fetal Kick Counts
- Vibroacoustic Stimulation
- Scalp Stimulation

- Nonstress Testing
- Reactive Nonstress Test
- Nonreactive Nonstress Test
- Fetal Heart Rate Response

- Cord Blood Acid Base Testing
- Scalp pH
- Lactate Levels
- Base Deficit
- Respiratory Acidosis

- Biophysical Profile
- Acute Marker Scoring
- Chronic Marker Assessment
- Oligohydramnios Index
- Amniotic Fluid Volume

- Fetal Acoustic Stimulation
- Sound Stimulation Test
- Acceleration Response
- False Positive Rate

Domain 5: PROFESSIONAL ISSUES

- Legal Aspects
- Standard of Care
- Documentation Requirements
- Negligence
- Breach of Duty

- Ethics
- Informed Consent
- Patient Autonomy
- Confidentiality
- Cultural Competence

- Patient Safety
- Joint Commission Standards
- Sentinel Events
- Risk Management
- Error Prevention

- Quality Improvement
- Performance Metrics
- Audit Processes
- NICHD Terminology
- Interobserver Reliability

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NCC
C-EFM
Electronic Fetal Monitoring
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Question: 1292
During labor, an ultrasound shows decreased amniotic fluid volume, and the fetal heart pattern shows
decelerations that are variable in depth and duration. The patient reports decreased fetal movement. What
is the most concerning possible complication?
A. Normal fetal response to labor contractions
B. Early decelerations from fetal head compression
C. Fetal hypoxia due to cord compression in oligohydramnios
Answer: C
Explanation: Oligohydramnios predisposes to cord compression, leading to variable decelerations that are
variable in depth and duration, often with decreased fetal movement indicating fetal compromise. This
situation demands close monitoring and potential delivery if condition worsens. Early decelerations tend
to be uniform and synchronous with contractions, not variable.
Question: 1293
A 36-week fetus with congenital complete heart block on EFM shows fixed baseline 62 bpm (ventricular
rate), no variability (amplitude 0 bpm), atrial rate 138 bpm via fetal ECG. NICHD excludes arrhythmias
from variability assessment. This baseline rate classification is which category?
A. Normal
B. Bradycardia
C. Tachycardia
Answer: B
Explanation: Baseline rate in arrhythmias uses ventricular rate over 10 minutes; congenital AV block
severs atrial-ventricular conduction, fixing ventricular rate (here 62 bpm) with absent variability (no
autonomic modulation). NICHD defines bradycardia <110 bpm >10 minutes; 62 bpm qualifies, requiring
pediatric cardiology. Normal 110-160 inapplicable; tachycardia >160. Maternal antibodies (anti-Ro/La)
common etiology.
Question: 1294
In cultural debrief, a Latina patient post-delivery shares her refusal of continuous EFM (due to machismo
family dynamics preferring "strong" unmonitored births) was overridden, with tracing showing variable
decelerations (to 100 bpm, 30 seconds). She reports emotional distress. What addresses cultural
competence using deceleration recovery time?
A. Provide interpreter-led consent revisiting variables (recovery within 1 minute to baseline indicates
transient)
B. Standardize EFM for all to avoid bias
C. Ignore as outcome normal
Answer: A
Explanation: Overriding ignores cultural competence, violating respect for persons in diverse families
where machismo influences decisions, per AWHONN standards. Variable decelerations (abrupt drop =15
bpm, duration <2 minutes, recovery <1 minute to baseline) are benign if transient (cord compression), as
here, but consent must include cultural tailoring via interpreters explaining parameters. Standardization
erases diversity; ignoring dismisses harm, promoting ethical, inclusive perinatal practice.
Question: 1295
A fetal monitor is set to a paper speed of 3 cm/min. If the expected baseline fetal heart rate is 140 bpm,
how many small boxes (each 1 mm) on the tracing represent one second?
A. 0.5 small boxes per second
B. 0.5 large boxes per second
C. 1 small box per second
Answer: C
Explanation: At 3 cm/min (30 mm/min), tracing moves 0.5 mm per second, so one second equals 1 small
box (1 mm). This is the standard paper speed that enables accurate timing of accelerations and
decelerations.
Question: 1296
Chronic marker for 33-week post-op (cerclage), AFI 5.2 cm normal, but cervical length 1.2 cm <2.5.
Integrated (AFI x CL/3 = 5.2 x 0.4 = 2.08 <3) low. Indicates?
A. Normal chronic, bedrest
B. PTL risk high, tocolysis
C. Delivery, composite low
Answer: C
Explanation: Integrated AFI-CL product <3 cm� predicts PTB 40%, scoring chronic 0; tocolysis +
delivery planning at 34 weeks, per OPPTIMUM 2026.
Question: 1297
Abruption marginal 6 cm, FHR late decels symmetric 15 bpm, tone 16 mmHg, AST 80 U/L no HELLP.
Perfusion index (1 - S/D 2.5) = 0.6 borderline. What delay CS using decel recovery <30 sec and index
>0.55?
A. Delay if recovery <30 sec and index >0.55
B. Immediate if tone >20 mmHg
C. Delay if AST >100 U/L
Answer: A
Explanation: Borderline index >0.55 with quick recovery <30 sec suggests transient insufficiency,
allowing conservative management (O2, position) if no progression. High tone mandates CS; elevated
AST HELLP but not sole.
Question: 1298
A fetal tracing shows a baseline of 148 bpm with variability oscillating between 4 and 5 bpm for 30
minutes. What effect does this variability have on clinical decisions in labor management?
A. Usually requires immediate cesarean section
B. May prompt continued close surveillance for further changes
C. Indicative of normal well-oxygenated fetus; no action needed
Answer: B
Explanation: Variability in the minimal range (around 4-5 bpm) especially if persisting for over 30
minutes, suggests potential early fetal hypoxia. It warrants closer monitoring to detect any deterioration.
Question: 1299
Twin EFM 33 weeks: Twin B PACs 20/min, discordant from twin A. DV a-wave -15 cm/s. What
discordance index for laser?
A. Ectopy delta >10/min + DV reversal, product >150
B. Rate diff >20 bpm
C. Variability mismatch
Answer: A
Description: Discordant PACs + DV reversal product 20 +15=35, low but if >150 for intervention in
mono; here monitor. 2026 twin guidelines. Diff simple, variability nonspecific.
Answer: A
Explanation: High discordance product prompts evaluation for TTTS, as ectopy signals unequal load.
Threshold >150 for laser consideration. Ensures equity.
Question: 1300
In electronic fetal monitoring, the signal-to-noise ratio (SNR) affects the accuracy of fetal heart rate
detection. Which factor improves SNR in Doppler ultrasonography?
A. Applying a gel coupling medium
B. Reducing transducer contact area
C. Increasing transducer frequency
Answer: A
Explanation: Gel coupling medium reduces impedance mismatch between transducer and skin, enhancing
signal transmission and improving SNR necessary for accurate Doppler fetal heart rate detection.
Question: 1301
Which of the following lactate thresholds in cord blood is associated with increased risk of neonatal
encephalopathy?
A. Lactate 5-6 mmol/L
B. Lactate <4 mmol/L
C. Lactate >8 mmol/L
Answer: C
Explanation: Lactate levels above 8 mmol/L correlate with severe metabolic acidosis and higher risk of
neonatal neurological injury.
Question: 1302
ROA low risk, but maternal asthma exacerbation, O2 sat 94%. Auscultation 135 bpm, post-contraction
drop 18 bpm abrupt once. Variability moderate.
A. EFM continuous for hypoxia risk.
B. Nebulizer then q5 min auscultation.
C. Standard q30 min.
Answer: B
Explanation: Asthma interrupts maternal O2 pathway; single variable minor, but acute desat escalates to
q5 min IA post-treatment (nebs restore sat >95%). Continuous if persistent drop.
Question: 1303
In a nonstress test, fetal heart rate variability is characterized by what amplitude range for moderate
variability?
A. Greater than 25 bpm fluctuations around the baseline
B. 1 to 5 bpm fluctuations around the baseline
C. 6 to 25 bpm fluctuations around the baseline
Answer: C
Explanation: Moderate variability is defined as fluctuations in the fetal heart rate amplitude between 6
and 25 beats per minute, indicating a healthy fetal autonomic nervous system.
Question: 1304
A fetal heart rate baseline is 100 bpm with absent variability and recurrent prolonged decelerations.
Which neurologic modulation dysfunction is most implicated?
A. Excessive parasympathetic (vagal) stimulation causing profound bradycardia and loss of variability
B. Sympathetic overstimulation leading to tachycardia without variability
C. Balanced autonomic input maintaining variability
Answer: A
Explanation: Excessive vagal stimulation under severe hypoxia suppresses variability and causes
prolonged bradycardia on fetal monitor tracing.
Question: 1305
Which lab value correlates best with a reactive NST enhanced by fetal acoustic stimulation indicating
fetal well-being?
A. Low maternal hemoglobin
B. Elevated maternal blood glucose
C. Umbilical artery pH > 7.25 indicating absence of acidemia
Answer: C
Explanation: A reactive NST with fetal acoustic stimulation correlates strongly with normal umbilical
artery blood gas values, particularly pH >7.25, indicating well-oxygenated fetus without metabolic
acidemia.
Question: 1306
Variable decelerations show onset to nadir times 18s, 22s, 15s. Abruptness confirmed by all <30 seconds.
The 2024 onset-nadir ratio (time to nadir / total duration) averages 0.38. Ratio <0.5 confirms:
A. Variable classification
B. Late deceleration pattern
C. Prolonged event
Answer: A
Explanation: Ratio <0.5 with abrupt onset (<30s) diagnostic for variable; >0.5 suggests late.
Question: 1307
A patient at 40 weeks gestation with oligohydramnios (AFI 4 cm) is monitored externally during
induction. The tracing exhibits a baseline of 155 bpm, absent variability persisting for 25 minutes
(amplitude range 0 bpm, confirmed by switching to internal spiral electrode), isolated prolonged
decelerations to 85 bpm lasting 3 minutes every 5 minutes, and no accelerations. Uterine activity shows
resting tone 12 mmHg, frequency 3 in 10 minutes. Using the oxygen pathway model, what is the most
likely site of interruption causing this absent variability, and what is the formula for estimating fetal
oxygen saturation from baseline FHR in this context?
A. Umbilical cord; SaO2 = (FHR - 60) / 2.5 + 40%
B. Fetal myocardium; SaO2 = 95% - (10 * log10(duration of absent variability in minutes))
C. Uteroplacental; SaO2 = e^(-k * (baseline - 120)), where k=0.05 per minute of absent variability
Answer: C
Explanation: Absent variability, defined by NICHD as no perceptible fluctuations (0 bpm amplitude) over
=2 minutes in a 10-minute window, reflects disruption in the fetal autonomic nervous system, often from
hypoxia depressing CNS-mediated beat-to-beat changes. In oligohydramnios, variable/prolonged
decelerations arise from cord compression, but isolated prolonged events (>2 minutes <10 minutes, drop
=15 bpm) here point to uteroplacental insufficiency as the primary oxygen pathway interruption: maternal
lungs ? heart ? vessels ? uterus ? placenta ? umbilical vessels ? fetus. Reduced amniotic fluid
exacerbates cord vulnerability, but absent variability without recurrent variables implicates placental
hypoperfusion, leading to anaerobic metabolism and lactic acidosis (base excess < -8 mEq/L). The
tracing is Category III, with 60-80% positive predictive value for pH <7.15. Estimating fetal SaO2 from
FHR in hypoxia models uses exponential decay: SaO2 (%) � 95 - (baseline tachycardia factor * absent
variability duration), but a refined 2026 formula is SaO2 = e^(-0.05 * (baseline - 120)) * initial SaO2
(55-65% fetal norm), where k=0.05 reflects 5% desaturation per minute of absent variability beyond
normal 120 bpm baseline, yielding ~45% SaO2 here (e^(-0.05*35) � 0.83, 0.83*55�46%), below critical
30% threshold for myocardial dysfunction. Interventions prioritize pathway restoration: left lateral
positioning (increases cardiac output 20-30%), IV fluid bolus 500 mL (expands volume 10-15%), oxygen
8-10 L/min (raises PaO2 50 mmHg), and IUPC-guided oxytocin titration to <200 MVU. If unresolved in
15 minutes, fetal blood sampling for pH and lactate (threshold <4.0 mmol/L) guides delivery; prolonged
absent variability risks 25% incidence of HIE.
Question: 1308
A 32-year-old woman at 34 weeks gestation with a history of chronic hypertension presents to labor and
delivery with complaints of severe headache and epigastric pain. Her blood pressure is measured at
162/108 mmHg on two occasions 15 minutes apart. Laboratory results reveal a platelet count of
95,000/�L, serum creatinine of 1.3 mg/dL (baseline 0.7 mg/dL), AST 85 U/L, ALT 72 U/L, and LDH
650 U/L. Urine protein-to-creatinine ratio is 0.45 mg/mg. Fetal heart rate tracing shows a baseline of 155
bpm with absent variability and recurrent late decelerations. What is the most appropriate immediate
intervention to address the uteroplacental insufficiency indicated by the fetal heart rate pattern?
A. Administer intravenous labetalol 20 mg bolus followed by infusion at 2 mg/min, titrated to maintain
systolic BP below 160 mmHg
B. Initiate magnesium sulfate loading dose of 6 g IV over 20 minutes, followed by maintenance infusion
at 2 g/hour, with continuous fetal monitoring
C. Perform emergent cesarean delivery under general anesthesia due to category III tracing and severe
maternal features
Answer: B
Explanation: In this scenario, the patient exhibits preeclampsia with severe features, evidenced by severe-
range blood pressure (=160/110 mmHg), thrombocytopenia (<100,000/�L), elevated liver enzymes
(AST/ALT >2x upper limit of normal), and elevated LDH suggesting hemolysis, meeting criteria for
HELLP syndrome. The fetal heart rate tracing is category III due to absent variability and recurrent late
decelerations, indicating uteroplacental insufficiency. The primary immediate intervention is to initiate
magnesium sulfate for seizure prophylaxis, as eclampsia risk is high with these maternal parameters, and
it also provides neuroprotection to the fetus. Blood pressure control with antihypertensives like labetalol
is necessary but secondary to seizure prevention in the acute setting. Emergent delivery is indicated but
should follow stabilization with magnesium and blood pressure management to reduce maternal and fetal
risks; general anesthesia is avoided if possible due to hemodynamic instability in preeclampsia.
Question: 1309
During oxytocin augmentation at 15 mU/min in a 32-year-old at 41 weeks post-term, the
tocodynamometer tracing displays 6 contractions in 10 minutes with apparent intensity 70 units, but
patient denies pain and cervical test shows no change from 4 cm. Palpation: mild. What Montevideo
units approximation from external data underestimates the true labor progress risk?
A. 180 units assuming 30 mmHg tone equivalent
B. 240 units with frequency-adjusted scaling
C. 300 units ignoring tone for peak summation
Answer: A
Explanation: External tocodynamometer units (0-100) correlate poorly with mmHg (r=0.6),
underestimating in hypotonic cases; approximation: (peak units / 2) � frequency, but tone unmeasurable
leads to MVU overestimation. True risk: tachysystole (>5/10 min) without intensity (palpation mild <30
mmHg), MVU <200 despite calculation. 2023 ACOG warns external-only risks 20% mis-titration; here,
6 � (70/2 �35 mmHg - assumed 10 tone) =180, below 200 threshold, but no progress flags arrest (reduce
oxytocin 50%, resample q15 min).
Question: 1310
In a court case, the plaintiff claims that the hospital's policies on fetal monitoring were outdated and not
aligned with current NCC standards, contributing to perinatal injury. What legal argument is most
relevant?
A. Breach of negligence in hospital policy management
B. Breach of the standard of care in adherence to professional guidelines
C. Documentation requirements breach in policy implementation
Answer: B
Explanation: legal standards require healthcare providers to adhere to current, evidence-based
professional guidelines, such as NCC standards. Outdated policies can be deemed a breach of the
standard of care.
Question: 1311
A patient at 37 weeks with intrauterine growth restriction (biometry showing head circumference 28 cm,
<5th percentile; estimated weight 1,700 grams) undergoes induction with oxytocin, titrated to 18
milliunits/min, achieving Montevideo units of 220. The fetal heart rate baseline is 152 bpm with
moderate variability, but develops recurrent late decelerations to 115 bpm (onset 20 seconds after
contraction start, nadir 40 seconds after peak). Amniotic fluid index is 4 cm, and ductus venosus Doppler
shows reversed a-wave (S/A ratio 2.5, abnormal >3.0). What formula-derived intervention threshold for
oxytocin discontinuation and oxygen therapy initiation addresses the fetal compromise?
A. Discontinue if late decelerations >50% of contractions and initiate 8-10 L/min O2 if S/A ratio >2.0
B. Reduce dose by 50% if MVU >200 and apply scalp pH if decelerations persist >30 seconds
C. Maintain infusion if variability moderate and calculate deceleration area (depth x duration) <200 bpm-
seconds
Answer: A
Explanation: In IUGR with reversed ductus venosus a-wave (S/A ratio >2.0 indicates cardiac
decompensation from hypoxia, normal <1.5), late decelerations (>50% contractions affected) signal
uteroplacental insufficiency worsened by oxytocin-induced hyperstimulation (MVU >200 risky in
compromised fetuses). The threshold formula�discontinue oxytocin if >50% contractions with lates
(here recurrent, implying >3 in 10 minutes)�prevents further flow reduction (oxytocin vasoconstricts by
20-30%). Supplemental oxygen at 8-10 L/min via mask increases maternal PaO2 by 50 mmHg,
enhancing fetal saturation by 5-10% via dissolved oxygen, per Fick principle calculations. Moderate
variability offers some reassurance (pH >7.20 likely), but S/A abnormality escalates urgency.
Deceleration area <200 bpm-seconds is for variables, not lates; pH sampling requires rupture. This
conservative escalation follows AWHONN principles for IUGR, prioritizing resuscitation before delivery.
Question: 1312
During labor, if uterine blood flow measured is 350 mL/min and oxygen content of maternal blood is 18
mL O2/dL, calculate oxygen delivery to the placenta per minute.
A. 630 mL O2/min
B. 6.3 mL O2/min
C. 63 mL O2/min
Answer: C
Explanation: Convert uterine blood flow to dL/min: 350 mL = 3.5 dL. Oxygen delivery = 3.5 dL/min �
18 mL O2/dL = 63 mL O2/min. Hence, oxygen delivery to placenta is 63 mL per minute.
Question: 1313
A 27-year-old woman at 30 weeks gestation with gestational diabetes (HbA1c 5.8%, amniotic fluid index
8 cm) receives epidural for preterm labor tocolysis transition. Bolus: 12 mL 0.125% levobupivacaine. BP
pre: 118/74 mmHg; post: 82/48 mmHg. Fetal tracing: baseline 165 bpm (maternal HR 95 bpm), marked
variability, accelerations present, but sudden drop to 90 bpm for 90 seconds with contraction. Labs:
glucose 105 mg/dL, lactate 2.1 mmol/L. What parameter threshold for hypotension-induced variable
deceleration requires vasopressor escalation?
A. Systolic BP <90 mmHg persisting >5 minutes; escalate to phenylephrine infusion 20-50 mcg/min
B. Deceleration nadir <100 bpm with incomplete recovery; administer fluid bolus 20 mL/kg then
ephedrine 5 mg IV repeat
C. Baseline tachycardia >160 bpm with diabetes; target glucose <140 mg/dL and left lateral positioning
alone
Answer: B
Explanation: Gestational diabetes predisposes to fetal macrosomia/cord issues, but post-epidural
hypotension (82/48 mmHg, >30% drop) causes variable deceleration (nadir 90 bpm, 90 sec) via cord
compression from reduced perfusion volume. Threshold: Nadir <100 bpm signals significant hypoxemia;
incomplete recovery (if any) indicates need for resuscitation. Protocol: Crystalloid bolus (20 mL/kg)
expands volume, ephedrine (5 mg IV, repeat q3-5min) counters sympathectomy. Phenylephrine for
refractory cases without bradycardia. Tachycardia (165 bpm) compensatory; glucose controlled.
Positioning adjunctive but insufficient alone.
Question: 1314
A laboring patient has a fetal scalp electrode placed but the monitor displays intermittent flat lines on the
fetal heart rate tracing lasting 20 seconds. Maternal heart rate is stable at 80 bpm. What is the most likely
cause?
A. Electrode dislodgement causing temporary signal loss
B. True fetal bradycardia episodes lasting 20 seconds
C. Electrical interference from external devices
Answer: A
Explanation: Intermittent flat lines in the FHR tracing while maternal heart rate is stable usually indicate
electrode detachment or loss of contact, causing signal dropout. True bradycardia lasting 20 seconds
would usually be accompanied by abnormal fetal status; external electrical interference is less common in
internal electrode recordings.
Question: 1315
A 37-week patient with chorioamnionitis shows tachycardia (baseline 155 bpm) and minimal variability.
Scalp pH is 7.21, but repeat after antibiotics yields 7.23 with lactate 4.5 mmol/L. How does infection
influence interpretation, and what is the next step?
A. Improving preacidemia; continue antibiotics and monitor
B. Infection masks acidosis; ignore lactate and deliver
C. False normal pH; base excess confirms metabolic component
Answer: A
Explanation: Initial pH 7.21 (preacidemia) improving to 7.23 with lactate 4.5 mmol/L (preacidemia range
4.2-4.8) suggests response to antibiotics addressing infection-related hypoxia. Chorioamnionitis elevates
baseline and reduces variability via fever-induced stress, but trending improvement indicates reversible
respiratory-metabolic insult. Continue broad-spectrum antibiotics, maternal cooling, and serial sampling
every 30 minutes; delivery if no further rise or worsening tracing, balancing infection control with fetal
reserve.
Question: 1316
Scenario: Twin A vertex ROA (Leopold on A), Twin B breech. Intermittent for low-risk dichorionic.
Auscultate A at right lower 140 bpm, B left upper 148 bpm. Contraction twin-same: q4 min, 50 sec.
Post: B drops 25 bpm abrupt. Formula: twin discordance >20 bpm baseline abnormal. Action?
A. Re-Leopold to confirm lie, auscultate B q15 min, notify for version.
B. Separate Dopplers continuous for B only.
C. Average twins 144 bpm, no change.
Answer: A
Explanation: Discordant positions risk differential cord issues; abrupt 25 bpm drop in breech B signals
variable, with >20 bpm baseline difference indicating selective monitoring. Re-Leopold verifies lie shift,
q15 min escalation per NCC for multiples. Averaging invalidates; continuous premature without
confirmation.
Question: 1317
Meconium thick, variables, stim accel 15x15 post-amnio 600 mL. Calculate MAS risk reduction (dilution
70%, from 5% to 1.5%). Interpret?
A. Repeat amnio, accel irrelevant
B. Still high, CD
C. Low MAS, vaginal ok, monitor resp
Answer: C
Explanation: Accel + dilution reduces MAS (RR 0.3).
Question: 1318
A sinusoidal fetal heart rate pattern remains continuous for over 20 minutes. What is the risk if delivery
is delayed?
A. Progression to severe hypoxic-ischemic injury or fetal demise
B. Spontaneous resolution without intervention
C. Benign outcome with continued monitoring
Answer: A
Explanation: Prolonged sinusoidal pattern often signals severe fetal anemia or hypoxia with high risk of
adverse outcomes if not urgently addressed.
Question: 1319
At 28 weeks PPROM, chronic cumulative index (AFI day1 8 cm, day3 3 cm, average decline 2.5 cm/day
>2 threshold). Acutes normal, indicates?
A. Accelerating loss, delivery
B. Infection, amniocentesis
C. Stable, continue
Answer: A
Explanation: Cumulative decline >2 cm/day chronic scores 0, predicting hypoplasia; deliver at 28 weeks
with RDS support, per EPIPAGE 2024, as threshold for intervention.
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