EFM Cheat Sheet 2026

The 30 highest-yield EFM facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. The threshold for significant metabolic acidemia in umbilical artery blood that is associated with risk of neonatal neurologic injury is a pH of: → < 7.10
2. In a twin gestation monitored with EFM, what is a major challenge unique to dual fetal monitoring? → Signal cross-capture where one transducer picks up the other twin's heart rate
3. Which of the following patterns is typically associated with cord compression? → C
4. How long must EFM paper strips be retained per standard US hospital accreditation requirements? → As part of the permanent medical record per state law, typically 7–10 years or longer
5. How would you describe the contractions noted on this fetal tracing? → Tachysystole
6. Which of the following is the primary purpose for measuring Montevideo Units (MVUs) with an Intrauterine Pressure Catheter (IUPC)? → To assess the adequacy of uterine power for labor progress
7. What is the baseline rate? → 170
8. Which condition best describes fetal asphyxia? → Hypoxia with significant metabolic acidosis and risk of organ damage
9. What is the likely cause of this fetal tracing? → Fetal anemia
10. When using closed-loop communication during a fetal emergency, the person receiving an order should: → Repeat the order back aloud and receive confirmation before executing
11. What is the appropriate next step if a prolonged deceleration persists after maternal position change? → Administering oxygen to the mother
12. Base excess (BE) in fetal cord blood is negative (base deficit) when: → Bicarbonate stores have been consumed by buffering excess acid
13. Which of the following is a recognized contraindication for performing fetal scalp stimulation? → Maternal active genital herpes infection
14. Are there accelerations present? → Yes
15. A patient at 41 weeks gestation is being monitored with EFM during oxytocin induction. Which pattern specifically increases risk in post-term fetuses? → Variable decelerations due to oligohydramnios increasing cord compression risk
16. Which of the following is the most important characteristic of fetal heart tracings to determine fetal well-being? → Variability
17. Which one of the following is associated with uteroplacental insufficiency? → B
18. What is the purpose of documenting maternal vital signs alongside the EFM strip during labor? → To correlate maternal hemodynamic changes with fetal heart rate patterns
19. Which type of acidosis is characterized by an elevated PCO2 and normal base deficit in fetal cord blood? → Respiratory acidosis
20. What is the primary purpose of the 'chain of command' in EFM-related clinical communication? → To escalate patient safety concerns when a provider does not respond appropriately
21. Metabolic acidosis in the fetus is primarily caused by: → Accumulation of lactic acid from anaerobic metabolism
22. During a uterine contraction, blood flow through the uterine spiral arteries temporarily decreases. What is the primary reason for this reduction in flow? → Increased intramyometrial pressure compressing the vessels
23. When caring for a laboring patient with a uterine rupture, which EFM finding typically occurs FIRST? → A prolonged or sudden fetal bradycardia
24. A clinician has classified a fetal heart rate tracing as Category II. Which of the following findings, on its own, would be consistent with this classification? → Marked variability
25. Which term should be used in documentation when describing a fetal heart rate pattern that cannot be categorized as Category I or Category III? → Category II
26. When a cesarean birth is performed for a non-reassuring fetal status, the 'decision-to-incision' time should ideally be documented within: → 30 minutes per ACOG guidelines
27. For a patient in active labor with chorioamnionitis, which combination of EFM findings would MOST raise concern for fetal compromise? → Fetal tachycardia with minimal variability and late decelerations
28. During EFM of a patient with intrauterine growth restriction (IUGR), which finding suggests the fetus has exhausted its compensatory reserves? → Absent or minimal baseline variability with repetitive late decelerations
29. Are there decelerations present? → None
30. Which standardized language is preferred when documenting uterine contraction frequency on an EFM strip per NICHD guidelines? → Contractions occurring every X minutes, averaged over 30 minutes