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NCC NNP-BC study materials
NCC NNP-BC study resources

NCC NNP-BC: Antepartum and Intrapartum Assessment and Care

NCC NNP-BC · Work through your exam, one topic at a time.

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Antepartum and Intrapartum Assessment and Care

What this domain tests

Antepartum and intrapartum questions ask you to interpret fetal surveillance and connect maternal and obstetric events to neonatal risk. You need NICHD terminology, not vague phrases such as nonreassuring.

Core rules

  • Baseline FHR 110-160 bpm. Variability: absent, minimal (<5), moderate (6-25), marked (>25).
  • Category I: normal baseline, moderate variability, no late or variable decelerations, accelerations present. Category III: absent variability with recurrent late or variable decelerations, bradycardia, or sinusoidal pattern. All else is Category II.
  • Before 32 weeks, accelerations may be 10 bpm for 10 seconds rather than 15/15.
  • Biophysical profile: NST, breathing, movement, tone, AFI; 8/10 is normal, 6/10 equivocal, 4 or less abnormal.
  • Umbilical artery Doppler: absent or reversed end-diastolic flow in FGR signals placental insufficiency and increased perinatal risk.
  • Antenatal betamethasone 12 mg IM twice, 24 hours apart, at 24-34 weeks reduces RDS, IVH, and mortality; best effect 24 hours to 7 days after dosing.
  • Magnesium sulfate before 32 weeks reduces cerebral palsy.
  • GBS prophylaxis: penicillin G 5 million units IV, then 2.5-3 million units every 4 hours; cefazolin for non-anaphylactic penicillin allergy.

Worked example

A 34-week fetus has minimal variability and recurrent variable decelerations after an epidural, with maternal hypotension. Reasoning: this is Category II, not Category III. Start intrauterine resuscitation: left lateral position, IV crystalloid bolus, stop oxytocin, and give oxygen only for maternal hypoxemia. If the pattern persists, prepare for delivery and alert the neonatal team for possible acidosis, need for PPV, and volume expansion.

Traps that cost marks

  • Labeling a strip rather than categorizing it.
  • Missing that a sinusoidal pattern is Category III and requires urgent delivery.
  • Treating late decelerations as benign variability.
  • Forgetting that GBS bacteriuria in this pregnancy is an indication for intrapartum prophylaxis.