Biophysical profile

Ultrasound

A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system,[1] with the score being termed Manning's score.[2] It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.

The "modified biophysical profile" consists of the NST and amniotic fluid index only.

Procedure

The BPP has 5 components: 4 ultrasound (US) assessments and a NST. The NST evaluates fetal heart rate and response to fetal movement. The five discrete biophysical variables:

  1. Fetal heart rate
  2. Fetal breathing
  3. Fetal movement
  4. Fetal tone
  5. Amniotic fluid volume
Parameter Normal (2 points) Abnormal (0 points)
NST/Reactive FHR At least two accelerations in 20 minutes Less than two accelerations to satisfy the test in 20 minutes
US: Fetal breathing movements At least one episode of > 30s or >20s[3] in 30 minutes None or less than 30s or 20s[3]
US: Fetal activity / gross body movements At least three or two[3] movements of the torso or limbs Less than three or two[3] movements
US: Fetal muscle tone At least one[3] episode of active bending and straightening of the limb or trunk No movements or movements slow and incomplete
US: Qualitative AFV/AFI At least one vertical pocket> 2 cm or more in the vertical axis Largest vertical pocket</=2 cm

Use of vibroacoustic stimulation to accelerate evaluation has been described.[4]

Interpretation

Each assessment is graded either 0 or 2 points, and then added up to yield a number between 0 and 10. A BPP of 8 or 10 is generally considered reassuring. A BPP normally is not performed before the second half of a pregnancy, since fetal movements do not occur in the first half . The presence of these biophysical variables implies absence of significant central nervous system hypoxemia/acidemia at the time of testing. By comparison, a compromised fetus typically exhibits loss of accelerations of the fetal heart rate (FHR), decreased body movement and breathing, hypotonia, and, less acutely, decreased amniotic fluid volume.

Recommended management based on the biophysical profile[5]
BPP Recommended management
≤2
4
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
8
  • Labor induction if presence of oligohydramnios

See also

References

  1. ↑ Alfirevic Z, Neilson JP (2000). Alfirevic, Zarko, ed. "Biophysical profile for fetal assessment in high risk pregnancies". Cochrane Database Syst Rev (2): CD000038. doi:10.1002/14651858.CD000038. PMID 10796097.
  2. ↑ Page 215, Chapter 39 on Biophysical Profile (BPP), in: Title: Diagnostic Ultrasound, Volume: 2, Issue: 1 of The Veterinary clinics of North America. Equine practice, Author: Norman W. Rantanen. Publisher: Jaypee Brothers Publishers, 1986. ISBN 9788184480641. Length: 261 pages
  3. 1 2 3 4 5 "Biophysical Profile, Ultrasound: eMedicine Radiology". Retrieved 2009-12-29.
  4. ↑ Pinette MG, Blackstone J, Wax JR, Cartin A (June 2005). "Using fetal acoustic stimulation to shorten the biophysical profile". J Clin Ultrasound 33 (5): 223–5. doi:10.1002/jcu.20116. PMID 16047387.
  5. ↑ Intrauterine Growth Retardation. ROBERT C. VANDENBOSCHE, M.D., and JEFFREY T. KIRCHNER, D.O., Lancaster General Hospital, Lancaster, Pennsylvania. Am Fam Physician. 1998 Oct 15;58(6):1384-1390.
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