The document discusses the biophysical profile (BPP) as a technique for assessing fetal well-being, particularly in high-risk pregnancies, focusing on five key parameters: non-stress test (NST), fetal movements, fetal breathing, muscle tone, and amniotic fluid volume. It outlines the scoring systems for these parameters, defines normal and abnormal results, and emphasizes the importance of fetal activity and monitoring through ultrasound and cardiotocography. The conclusion highlights the balance in antepartum management of high-risk pregnancies and the role of fetal surveillance tests, particularly the NST, in ensuring fetal health.

1. METRO COLLEGE OF
NURSING
BIOPHYSICAL PROFILE
SANDHYA KUMARI
Nursing Tutor (OBG)
MCON, Greater Noida

2. INTRODUCTION
• It is a technique employed to forecast fetal well-being focus on fetal biophysical findings
that include heart rate, movement, breathing, and amniotic fluid production
• It contains 5 parameters; non stress test (NST), fetal breathing, fetal movements, muscle
tone and amniotic fluid volume
• Modified Biophysical Profile consists of NST and ultrasono graphically determined
amniotic fluid index (AFI)
• Modified BPP is considered abnormal (non reassuring) when the NST is non-reactive
and/or the AFI is < 5.
• The BPP is most common in the third trimester

3. DEFINITION
• The biophysical profile is a test used to evaluate the well-being of the
fetus. The biophysical profile uses ultrasound and cardiotocography
(CTG), also known electronic fetal heart rate monitoring, to examine the
fetus. There are five components measured during the biophysical
examination. A score of 2 points is given for each component that meets
criteria as listed in the table below. The test is continued until all criteria
are met or 30 minutes have elapsed. The points are then added for a
possible maximum score of 10.

4. NONSTRESS TEST
• Currently, non stress test is the most widely used primary testing method
for assessment of fetal well-being
• It describes FHR acceleration in response to fetal movement as a sign of
fetal health
• Involved the use of Doppler-detected FHR acceleration coincident with
fetal movements perceived by the mother
• As hypoxia develops, these fetal heart rate accelerations diminish

5. NORMAL RESULT
• Two or more accelerations that peak at 15 bpm or more above baseline,
each lasting 15 seconds or more, and all occurring within 20 minutes of
beginning the test
• A 40-minute or longer tracing to account for fetal sleep cycles should be
performed before concluding that there was insufficient fetal reactivity
• 1 acceleration was just as reliable as 2 in predicting healthy fetal status
• Also accelerations with or without fetal movements may be accepted

6. ABNORMAL RESULT
• Baseline oscillation of less than 15 bpm,
• Absent accelerations,
• Late decelerations with spontaneous uterine contractions
• Abnormal results were associated consistently with evidence of utero
placental pathology

7. EXAMPLE
• IUGR
• Oligohydramnios
• Meconium
• Interval between testing set at 7 days; but more frequent testing is
advocated for women with post-term pregnancy, multifetal gestation, type
1 diabetes mellitus, IUGR, or gestational hypertension
• In these circumstances, twice-weekly tests, with additional testing is
advised

8. FETAL MOVEMENTS
• Passive unstimulated fetal activity commences as early as 7 weeks’
gestation and becomes more sophisticated and coordinated by the end of
pregnancy
• Between 20 and 30 weeks, general body movements become organized,
and by 36 weeks behavioural states are established in most normal
foetuses

9. Four fetal behavioural states described
• State 1F is a quiescent state; quiet sleep, with a narrow oscillatory
bandwidth of the FHR
• State 2F includes frequent gross body movements, continuous eye
movements, and wider oscillation of the FHR. It is analogous to REM or
active sleep in the neonate
• State 3F includes continuous eye movements in the absence of body
movements and no heart rate accelerations
• State 4F is one of vigorous body movement with continuous eye
movements and heart rate accelerations. This state corresponds to the
awake state in newborns

10. CONTINUE
• State 4F is one of vigorous body movement with continuous eye
movements and heart rate accelerations. This state corresponds to the
awake state in newborns
Fetuses spend most of their time in states 1F and 2F (>75% at 38 weeks)
Mean length of the quiet or inactive state for term fetuses was 23 minutes
(up to 75min)
Amniotic fluid volume is another important determinant of fetal activity
Perception of 10 fetal movements in up to 2 hours is considered normal.

11. FETAL BREATHING
• The first are gasps or sighs, which occurred at a frequency of 1 to 4 per minute
• The second, irregular bursts of breathing, occurred at rates up to 240 cycles per minute
• These latter rapid respiratory movements were associated with REM sleep
• Diurnal variation, because breathing substantively diminishes during the night
• But, increases somewhat following maternal meals
• Total absence of breathing was observed in some normal fetuses for up to 122 minutes,
indicating fetal evaluation to diagnose absent respiratory motion may require long periods
of observation.

12. AMNIOTIC FLUID VOLUME
• Decreased utero placental perfusion may lead to diminished fetal renal
blood flow, decreased urine production, and ultimately, oligohydramnios
• Amniotic fluid index < 5 cm or a maximum deepest vertical pocket < 2 cm
are acceptable criteria for diagnosis of oligohydramnios
• Normal; ≥ 1 pocket measuring 2 cm in two perpendicular planes (2 × 2 cm
pocket).

13. FETAL MUSCLE TONE
• Normal; ≥ 1 episode of extension (limb or trunk) with return of
flexion.
• The ability to flex and extend an arm or leg, measured by
counting quick, jerky movements.

14. Component Normal (2 points) Abnormal (0 points)
Fetal Breathing Movements
One or more episodes of fetal
breathing lasting at least 30
seconds within 30 minutes.
No episodes of fetal breathing
movements lasting at least 30
seconds during a 30 minute
period of observation.
Gross Body Movement
3 or more discrete body or limb
movements within 30 minutes
Less than 3 body or limb
movements in 30 minutes
Fetal Tone
One or more episodes of active
extension and flexion of a fetal
extremity OR opening and closing of
the hand within 30 minutes
Slow extension with no return
or slow return to flexion of a
fetal extremity OR no fetal
movement
Amniotic Fluid Volume
A single deepest vertical pocket of
amniotic fluid measures greater than
2 centimeters. is present
A single deepest vertical
pocket of amniotic fluid
measures 2 centimeters or less
Non-stress test (NST) Reactive Nonreactive

15. CONTINUE
• Amniotic Fluid Volume: Measured as the vertical measurement , in centimeters,
of the single deepest pocket of amniotic fluid with a transverse measurement of 1
cm or more wide without fetal small parts or umbilical cord
• Reactive: Two or more fetal heart rate accelerations that peak (but do not
necessarily remain) at least 15 beats per minute above the baseline and last at
least 15 seconds from baseline to baseline during 20 minutes of observation
• Nonreactive: Less than two accelerations of fetal heart rate as described above
after 40 minutes of observation

16. INTERPRETATION OF THE SCORE
• 8-10; no fetal asphyxia, repeat weekly
• 6; suspected chronic asphyxia, if >36 weeks deliver, if less repeat test in 4-
6hours
• 4 and below; strongly suspect asphyxia, if >36weeks deliver, if not repeat
after 4-6 hours for 120minutes, persistent score <5 deliver regardless

17. CONTRACTION STRESS TEST
• Formerly known as oxytocin challenge test
• Intravenous diluted oxytocin was used to stimulate contractions, and the FHR
response was recorded
• The criterion for a positive test result, that is, an abnormal result, was uniform
repetitive late fetal heart rate decelerations (which could be the result of utero
placental insufficiency)
• Nipple stimulation to induce uterine contractions is usually successful for
contraction stress testing
• 2-minute nipple stimulation ideally will induce a pattern of 3 contractions per 10
minutes, if not after 5 minutes, retry, if unsuccessful, diluted oxytocin.

18. ULTRASONOGRAPHY
• Low power sound: 100 mW
• Frequency:>20,000/cycle
Uses:
• Diagnose pregnancy at 6 weeks
• Locate placenta
• Diagnose fetal abnormalities
• Establish fetal sex

19. CONTINUE
• Discover problems
• Oligo/polyhydramnios
• Ectopic pregnancy
• Miscarriage
• Placenta previa
• PROM
• Down’s syndrome, NTDs, diaphragmatic hernia

20. CONTINUE
• Predict maturity of fetus
• Crown to rump length For dating, accuracy is
• +/- 3days (7-10 weeks)
• +/- 5days(10-14wks)
• Bi parietal diameter(most reliable at 12-20wks)
• +/- 5-7 days(16 weeks)
• +/- 3weeks >28 weeks

21. CONTINUE
• Bi parietal diameter (most reliable at 12-20wks)
• +/- 5-7 days (16 weeks)
• +/- 3weeks >28 weeks
• Cephalic index=BPD/occipito frontal diameter
• Normal is 0.74-0.83

22. CONTINUE
• Head
• Circumference=(BPD+OFD)
• Used to determine:
• Gestational age
• IUGR
• Microcephaly

23. CONTINUE
• Abdominal
• Circumference
• Used from 16 weeks to term
• To determine gestational age
• Femur length
• Obtained as early as 10 weeks

24. NURSE’S RESPONSIBILITY
• Full bladder
• Draping
• Towel roll under her right buttock
• No risk to fetus from procedure

25. MODIFIED BIOPHYSICAL PROFILE
• NST +AFI:
• Abnormal when one / both is abnormal
• Time -20 minutes
• Procedure:
• Standard NST
• No acceleration within 5 min
• 1-2 sec stimulation (upto 3 times)
• Normal :2 acceleration within 10 min

26. GUIDELINES
• If both normal: weekly fetal surveilance
• If both abnormal:
• >36 weeks: delivery
• <36 weeks: doppler, BPP, CST
• If AFI less: search for placental insufficiency
• If NST nonreactive: doppler, CST, BPP

27. CT SCAN
• Better to be avoided in pregnancy
MRI SCAN
• Obstetric applications
• Known/suspected Hydatidiform mole
• Placenta previa
• Fetal anomalies
• IUGR

28. CONCLUSION
• Antepartum management of high-risk pregnancies involves a balance of
risks. Early delivery to minimize the morbidity and mortality associated
with the high-risk condition may lead to severe morbidity or even
mortality as a result of prematurity complications. Fetal surveillance tests
have been developed to assess well-being at the time of the test and the
statistical likelihood of future fetal well-being during a specified interval
of time. In the USA the NST is widely used for primary surveillance of
fetal well-being in high-risk pregnancies