BIOPHYSICAL PROFILE

Dr. Ismail Alvi

What

A noninvasive test that predicts the presence or absence of fetal asphyxia and,
ultimately,

the risk of fetal death in the antenatal period.

When the BPP identifies a compromised fetus, measures can be taken to intervene before progressive metabolic acidosis leads to fetal death.

Biophysical Profile

Separate from an Obs scan Performed in 3rd trimester 5 parameters are checked and scored (0 or 2).
Fetal

movement Fetal tone Fetal breathing Amniotic fluid volume Results of non-stress testing

Why - Indications

Post-maturity Lack of fetal activity Gestational diabetes SGA Loss of amniotic fluid Maternal anxiety

How

Biophysical Variable
Fetal breathing movements*

Normal (Score = 2)
1 or more episodes of 20 s within 30 min

Abnormal (Score = 0)
Absent or no episode of 20 s within 30 min

Gross body movements

2 or more discrete body/ limb movements within 30 min (episodes of < 2 episodes of body/limb active continuous movement movements within 30 min considered as a single movement) Slow extension with return 1 or more episodes of active extension to partial flexion, movement with return to flexion of fetal limb(s) or of limb in full extension, trunk (opening and closing of hand absent fetal movement, or considered normal tone) partially open fetal hand 1 or more episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min

Fetal tone

2 or more episodes of acceleration of 15 beats per minute (bpm) and of >15 Reactive FHR s associated with fetal movement within 20 min Qualitative AFV

Either no pockets or largest 1 or more pockets of fluid measuring 2 pocket < 2 cm in vertical cm in vertical axis axis

Fetal breathing movements should include 1 or more episodes of rhythmic fetal breathing for at least 30 s or more in 30 min. Manning et al's

Biophysical Variable
Fetal breathing movements*

Normal (Score = 2)
1 or more episodes of 20 s within 30 min

Abnormal (Score = 0)
Absent or no episode of 20 s within 30 min

Gross body movements

2 or more discrete body/ limb movements within 30 min (episodes of < 2 episodes of body/limb active continuous movement movements within 30 min considered as a single movement) Slow extension with return 1 or more episodes of active extension to partial flexion, movement with return to flexion of fetal limb(s) or of limb in full extension, trunk (opening and closing of hand absent fetal movement, or considered normal tone) partially open fetal hand 1 or more episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min

Fetal tone

2 or more episodes of acceleration of 15 beats per minute (bpm) and of >15 Reactive FHR s associated with fetal movement within 20 min Qualitative AFV

Either no pockets or largest 1 or more pockets of fluid measuring 2 pocket < 2 cm in vertical cm in vertical axis axis

Fetal breathing movements should include 1 or more episodes of rhythmic fetal breathing for at least 30 s or more in 30 min. Manning et al's

Biophysical Variable
Fetal breathing movements*

Normal (Score = 2)
1 or more episodes of 20 s within 30 min

Abnormal (Score = 0)
Absent or no episode of 20 s within 30 min

Gross body movements

2 or more discrete body/ limb movements within 30 min (episodes of < 2 episodes of body/limb active continuous movement movements within 30 min considered as a single movement) Slow extension with return 1 or more episodes of active extension to partial flexion, movement with return to flexion of fetal limb(s) or of limb in full extension, trunk (opening and closing of hand absent fetal movement, or considered normal tone) partially open fetal hand 1 or more episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min

Fetal tone

2 or more episodes of acceleration of 15 beats per minute (bpm) and of >15 Reactive FHR s associated with fetal movement within 20 min Qualitative AFV

Either no pockets or largest 1 or more pockets of fluid measuring 2 pocket < 2 cm in vertical cm in vertical axis axis

Fetal breathing movements should include 1 or more episodes of rhythmic fetal breathing for at least 30 s or more in 30 min. Manning et al's

Biophysical Variable
Fetal breathing movements*

Normal (Score = 2)
1 or more episodes of 20 s within 30 min

Abnormal (Score = 0)
Absent or no episode of 20 s within 30 min

Gross body movements

2 or more discrete body/ limb movements within 30 min (episodes of < 2 episodes of body/limb active continuous movement movements within 30 min considered as a single movement) Slow extension with return 1 or more episodes of active extension to partial flexion, movement with return to flexion of fetal limb(s) or of limb in full extension, trunk (opening and closing of hand absent fetal movement, or considered normal tone) partially open fetal hand 1 or more episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min

Fetal tone

2 or more episodes of acceleration of 15 beats per minute (bpm) and of >15 Reactive FHR s associated with fetal movement within 20 min Qualitative AFV

Either no pockets or largest 1 or more pockets of fluid measuring 2 pocket < 2 cm in vertical cm in vertical axis axis

Fetal breathing movements should include 1 or more episodes of rhythmic fetal breathing for at least 30 s or more in 30 min. Manning et al's

Biophysical Variable
Fetal breathing movements*

Normal (Score = 2)
1 or more episodes of 20 s within 30 min

Abnormal (Score = 0)
Absent or no episode of 20 s within 30 min

Gross body movements

2 or more discrete body/ limb movements within 30 min (episodes of < 2 episodes of body/limb active continuous movement movements within 30 min considered as a single movement) Slow extension with return 1 or more episodes of active extension to partial flexion, movement with return to flexion of fetal limb(s) or of limb in full extension, trunk (opening and closing of hand absent fetal movement, or considered normal tone) partially open fetal hand 1 or more episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min

Fetal tone

2 or more episodes of acceleration of 15 beats per minute (bpm) and of >15 Reactive FHR s associated with fetal movement within 20 min Qualitative AFV

Either no pockets or largest 1 or more pockets of fluid measuring 2 pocket < 2 cm in vertical cm in vertical axis axis

Fetal breathing movements should include 1 or more episodes of rhythmic fetal breathing for at least 30 s or more in 30 min. Manning et al's

Factors Affecting BPP

Activity Fetal sleep Early gestational age (< 33 wk) Late gestational age (>42 wk) Maternal glucose ingestion Maternal alcohol ingestion

FHR Acceleratio ns

Tone

Gross Movement

Fetal Breathing

AFV

Maternal magnesium administration

Artificial rupture of membranes Premature rupture of membranes Labor

What to do
BPP
2 Labor induction Labor induction if gestational age >32 weeks Repeating test same day if <32 weeks, then delivery if BPP <6 Labor induction if >36 weeks if favorable cervix and normal AFI Repeating test in 24 hours if <36 weeks and cervix unfavorable; then delivery if BPP <6, and follow-up if >6 Labor induction if presence of oligohydramnios

Recommended management

Breathing Movements

Simultaneous movement of the chest wall with outward movement of the anterior abdominal wall during inspiration.
points if one episode of 30s duration is seen within a 30 min scan time 0 points none observed
2

Fetal Tone

Presence of atleast one episode of extension and immediate return to flexion of an extremity or the spine

One active extension & flexion of an open & closed hand is a good example of fetal tone.

AFI

A semiquantitative method for evaluating the AFV. Adding the largest vertically measured fluid pocket from each uterine quadrant. Using this method, oligohydramnios is defined as an AFI of less than 5. The largest pocket of fluid in each quadrant is measured along the vertical dimension, which is the dimension perpendicular to the ultrasonographic probe. The pockets must be free of umbilical cord or fetal extremities, although brief appearances of these are acceptable.

Applications

Should not be performed earlier than the gestational age at which extrauterine survival or active intervention for fetal compromise is possible For patients with a low probability of successful induction, the BPP is a useful tool that can be used while waiting for cervical ripening. In these patients, the purpose of the BPP is to avoid the maternal morbidity resulting from failed induction followed by cesarean delivery.

Reliability

The biophysical profile (BPP) is a reliable method of predicting fetal survival. The BPP has a false-negative mortality rate of 0.77 deaths per 1000 tests. Furthermore, the BPS highly correlates with the antepartum fetal umbilical venous cord pH level. In a study, cordocentesis performed immediately following a BPP demonstrated that a poor BPS was always associated with a pH of less than 7.20, while a score of 10 of 10 always yielded a pH of greater than 7.20.

AFI

Movements

Breathing movements

Thank You!