BIOPHYSICAL PRO.pptx in which you learn about fetal biophysical profile parameter, non-stress test, CTG,AFI, Vibroacoustic stimulation test, fetal acceleration, fetal deceleration, FHS monitoring.

1. TOPIC = BIOPHYSICAL PROFILE
PRESENTED BY
AYUSHI CHAVHAN
MSC (N)PREV YEAR
CCON

2. BIOPHYSICAL PROFILE
• INTRODUCTION
• A biophysical profile is a non-invasive test that doesn’t pose any
physical risks to you or your baby.
• Typically, a biophysical profile is recommended for women at
increased risk of problems that could lead to complications or
pregnancy loss. The test is usually done after 32 weeks of pregnancy,
but can be done when your pregnancy is far enough along for delivery
to considered- usually after 24.

3. DEFINITION
• A fetal biophysical profile is a prenatal test used to check on a baby’s
well- being. The test combines fetal heart rate monitoring (nonstress
test) and fetal ultrasound to evaluate a baby’s heart rate, breathing,
movements, muscle tone and amniotic fluid level.
WIKIPEDIA
• A non -invasive assessment of the fetus and its environment by
ultrasound, nothing normal and abnormal biophysical responses to
stimuli.
• A normal BPP indicates that the CNS is functional and the fetus is not
hypoxemic.
• A scoring system, of 5 variables, with a total score up to 10.

4. • The following biophysical tests are used:
1)Fetal movement count
2)Cardiotocography
3)Non stress test (NST)
4)Fetal biophysical profile (BPP)
5)Amniotic fluid volume
6)Contraction stress test (CST)
7)Doppler ultrasound
8)Vibroacoustic stimulation test
9)Contraction stress test (CST)

5. 1) FETAL MOVEMENT COUNT
• Fetal movement felt by 18-20 weeks
• Fetal movement count should be performed daily starting at 28 weeks
of pregnancy.
• Methods
• a) Cardiff count 10 formula
• b) Daily fetal movement count

6. a)Cardiff count 10 formula: The patient counts fetal movements. The
counting comes to the end as soon as 10 movements are perceived.
• She instructed to report the physician if-
i) Less than 10 movements occur during 12 hours on 2 successive days
ii)No movement is perceived even after 12 hours in a single day.
a)Daily fetal movement count: Three counts each of 1 hour duration
(morning, noon, evening) are recommended. The total counts multiplied
by four gives daily (12 hours) fetal movement count.
• If there is diminution of the number of ‘kicks’ to less than 10 in 12
hours (or less than 3 in each hour) it indicates fetal compromise.
•
• Maternal perception of fetal movement may be reduced with fetal
sleep(quiet), fetal anomalies, drugs(narcotics), chronic smoking and
hypoxia.

7. • MANAGEMENT OF REDUCED FM
• Eat something
• Rest in a left lateral position
• Count fetal movement
• If 10 movements /hour reassure mother
• If <10 movements/hour go for NST.

8. 2) CARDIOTOCOGRAPHY

9. 2) CARDIOTOCOGRAPHY
• Cardiotocography is a technical means of recording (-graphy) the
fetal heart beat (cardio-)and the uterine contraction (toco)during
pregnancy, typically in third trimester. The machine used to perform
the monitoring is called a cardiotocography, more commonly known
as an electronic fetal monitoring (EFM).
• INVENTION
The invasive fetal monitoring was invented by doctor Orvan Hess
and Edward hon
A refined (antepartal, non-invasive, beat to beat) version
(cardiotocograph)was later developed for Hewlett Packard by dr Konrad
hammacher)

10. • PURPOSE
• To record FHS continuously
• To check uterine activity
• To detect any fetal distress
• To gain information about rate, rhythm of the fetal heart rate
• INDICATION FOR THE USE OF CONTINOUS EFM
• Continuous EFM should be offered and recommended for high-risk
pregnancies where there is an increased risk of perinatal death, cerebral
palsy or neonatal encephalopathy
• Continuous EFM should be used where oxytocin is being used for
induction or augmentation of labour.

11. • HIGH RISK INDICATIONS
• Maternal medical illness
• Gestational diabetes
• Hypertension
• Asthma
• Obstetric complications
• Multiple gestation
• Post-date gestation
• Previous caesarean section
• Intrauterine growth restriction
• Oligohydramnios
• Pre mature rupture of membrane

12. • Pre mature rupture of membrane
• Congenital malformations
• Third trimester bleeding
• Oxytocin induction/augmentation of labour
• Pre-eclampsia
• Meconium-stained liquor
• METHODS
• External cardiotocography
• Internal cardiotocography

13. External cardiotocography
• For continuous or intermittent monitoring of
• The fetal heart rate
• The activity of the uterine muscle
• Placed two transducers on the mother’s abdomen (one above fetal heart and
the other at the fundus)
• The tocodynamometer (toco)is placed over the uterine fundus. The toco
provides information that can be used to monitor uterine contraction
• The ultrasound device placed over the area of the fetal back. this device
transmits information about FHR.

14. • Internal monitoring
• Uses an electronic transducer connected directly to the fetal scalp
through the cervical opening and is connected to the monitor
• Criteria for internal monitoring
• Amniotic dilated 2 cm
• Cervix dilated 2 cm
• Presentation must be cephalic
• Presenting part down against the cervix

15. • PROCEDURE
• Equipment’s
• Cardiotocograph
• Transducer (2): Toco and cardio
• Conduction gel or paste
• Abdominal binder (two belts)
• Monitor paper
• Tissue paper

16. • Preparation for CTG
• Determine the indication for fetal monitoring
• Explain the purpose, time required for test
• Instruct the women for empty the bladder
• Place the women in supine position
• Uncover the abdomen
• Procedure
• Place the toco sensor on the fundus of uterus and fix it with abdominal
binder
• Identify the presentation and position of the fetus
• Localize the FHS and fix it with abdominal binder
• Assure the recording of FHS and uterine contraction
• Explain the mother to push the bottom when she feel any movements
• Labelled the women’s name, IP Number, date and time in graph

17. • Explain the mother to push the bottom when she feel any movements
• Labelled the women’s name, IP Number, date and time in graph
• Turn off the monitor and replace
• Read the CTG and immediately notify the doctor, if any abnormality seen
• Interpretation
• Uterine activity (contraction)
• Baseline fetal heart rate (FHR)
• Baseline FHR variability
• Presence of accelerations
• Periodic or episodic decelerations
• Changes or trends of FHR patterns over time.

18. • BASELINE FETAL HEART RATE
• The mean level of the FHR when this is stable, excluding accelerations and decelerations. It is determined
over a period of 5 or 10 minutes and expressed in bpm.
• Normal baseline FHR 110-160bpm
• Moderate bradycardia 100-109bpm
• Moderate tachycardia161-180bpm
• Abnormal bradycardia <100bpm
• Abnormal tachycardia>180bpm

19. • BASE LINE VARIABILITY
• Variability refers to the normal beat to beat changes in FHR
• Normal variability is between 5-15bpm
• The fluctuations are visually quantities as the amplitude of the peak-to-
trough in bpm
• Using this definition, the baseline FHR variability is categorized by the
quantitated amplitude as:
• Absent- undetectable
• Minimal -greater than undetectable, but less than or equal to 5bpm
• Moderate -6-25bpm
• Marked -greater than 25bpm

21. • ACCELERATIONS
• To be called an acceleration, the peak must be greater than or equal to
15bpm, and the acceleration must last greater than or equal to 15
seconds from the onset to return to baseline

22. • DECELERATIONS
• Decrease in fetal heart rate from the baseline by at least 15b/m, lasting
for at least 15 seconds.
• 3types
• Early- head compression
• Late- u-p insufficiency
• Variable-cord compression primary CNS dysfn

24. NON STRESS TEST(NST)

25. Nonstress testing (NST)
• Definition
• A testing that monitors the fetal heart rate in response to fetal
movement in order to assess the integrity of fetal central nervous system
and cardio vascular system.
• The non-stress test (NST) involves application of the fetal monitor to
record the fetal heart rate. the mother is instructed to push a maker
button when she feels the fetus move. The marker button indicates the
movement as it occurred the relationship to the fetal heart rate. with
sufficient placental functioning, the fetus should demonstrate an
acceleration in heart rate with movement, in the same way that the
adult experienced increase heart rate with exercise. A lack of fetal
heart rate acceleration indicates the need for further testing

26. 1) Non-stress test is used to screen the high-risk pregnancy where the placenta
compromise is anticipated to include post- term pregnancy, pregnancy
induced hypertension, gestational diabetes, intrauterine growth retardation,
and maternal complaints of decreased fetal movement.
2) Patient identified as NST candidates will generally be required to complete
an NST on a regular basis (that is, weekly- bi weekly)
• PURPOSES
 To assess the fetal ability to cope with continuation of a high-risk
pregnancy.
 To determine the projected ability of a fetus to withstand the stress of
labour.

27. • INDICATION
• MATERNAL
• Post-dated pregnancy
 RH sensitization
 Maternal age 35 or more
 Chronic renal disease
 Hypertension
 Collagen disease
 Sickle cell disease
 Diabetes

28. FETAL
• Decreased fetal movement
• Intrauterine growth retardation (IUGR)
• Fetal evaluation after amniocentesis
• Oligohydramnios/polyhydramnios

29. • ARTICALS
 Electronics fetal heart monitor
 Ultrasound transducer
 Tocotransducer (Tocodynamometer)
 Monitor strip
 Ultrasound gel
 Belts to hold the transducer in place

30. • RESULT
• Reactive non stress test =NORMAL /NEGATIVE
• reactive indicates a healthy fetus. The result requires two or more
FHR accelerations of at least 15 beats per minutes, lasting at least 15
seconds from the beginning of the acceleration to the end, in
association to the end, in association with fetal movement, during a
20 min period
• Non-reactive nonstress test=ABNORMAL

31. • No acceleration or accelerations of less than 15 beats per min or
lasting less than 15 sec in duration occur during a 40 min
observation. the result cannot be interpretated because of the poor
quality of the FHR tracing
• Unsatisfactory
• The result cannot be interpretated because of the poor quality of the
FHR tracing

32. 3) FETAL BIOPHYSICAL PROFILE
• Considers several parameters. BPP using real time ultrasonography has a high
predictive value
• Indication
• Non-reactive NST
• High risk pregnancy
• MODIFIED BIOPHYSICAL PROFILE
• Consist of NST and ultra sonographically determined amniotic fluid index (AFI).
Modified BPP is considered abnormal (nonreassuring) when the NST is non-
reactive and /of the AFI is <5

33. BIOPHYSICAL PROFILE SCORING (MANNING MODIFIED-
1992)

34. BPP SCORING, INTERPRETATION AND MANAGEMEN

35. 4) AMNIOTIC FLUID INDEX
• Introduction
• It is clear, yellowish fluid that surrounds and protect fetus in uterus during
pregnancy
• It is also known as liquor amnii
• It is present in amniotic sac
• Origin
• Mixed maternal and fetal origin
• Volume
• Volume related to gestational age
• At 12 weeks=50ml
• At 20 weeks=400ml

36.  At 36-38week=1000ml
 At term=600ml-800ml
 At 43week=200ml
• AMNIOTIC FLUID INDEX
• It is most commonly used method for amniotic fluid volume assessment
• Uterus divided into four equal quadrant-right, left, upper and lower quadrants
• AFI is the sum of the single deepest pocket from each quadrant
• Single deepest pocket measurement
• The ultrasound transducer is held perpendicular to the floor and parallel to the long axis
of the pregnant women
• The AFI is the sum of the single deepest pocket from each quadrant

37. • A fluid pocket may contain fetal parts or umbilical cord loops, but these are
not included in measurement
• Colour doppler is generally used to verify that no umbilical cord is included
in the measurement.
• Normal AFI is between 8-18cm
• Amniotic fluid abnormalities
• Oligohydramnios
• Defined as reduced amniotic fluid of 200ml or less i.e., amniotic fluid index
of 5cm or less or the deepest vertical pool<2cm
• Polyhydramnios
• Defined as excessive amount of amniotic fluid of 2000ml or more (AFI of
>25 cm or the deepest vertical pool of >8cm)

38. 5) OXYTOCIN CHALLENGE TEST (OCT)
(CONTRACTION STRESS TEST)
• DEFINITION
• A test in which the fetus is exposed to the stress of contractions to
determine whether there is adequate placental perfusion under simulated
labour conditions (induced uterine contraction).
• PURPOSES
• To assess the fetal ability to cope with the continuation of a high risk
pregnancy
• To determine the projected ability of the fetus to withstand the stress
of labour

39. • INDICATION
• IUGR
• Post maturity
• Hypertensive disorders of pregnancy
• Diabetes mellitus
• Women with nonreactive NST
• CONTRAINDICATION
• Third trimester bleeding
• Incompetent cervix
• Multiple gestation
• Previous classical uterine incision

40. • Hydramnios
• History of preterm labour
• Premature rupture of membrane
• ARTICLES
• All the articles required for NST (Fetal monitor, monitor strip,
transducer and monitor belts)
• An IV line to administer a dilute dose of oxytocin
• IV Infusion pump to monitor the flow rate
• Medication and IV fluids.

41. • PROCEDURE
• A dilute of IV solution of oxytocin is administered to the mother until
a contraction pattern is developed. when sufficient information is
obtained to evaluate the test, the medication is turned off.
• The oxytocin challenge test evaluates the ability of the placenta to
supply fetal needs in a stressed environment. contractions, such as
those of labor, are a stress on the pregnancy. During a contraction, the
flow of oxygen from the uterus to the placenta is diminished. The
healthy placenta stores an oxygen reserve so that the fetus does not
suffer a diminished supply of oxygen during the contraction.

42. • The OCT involves application of the fetal monitor to record fetal
heart rate and contraction activity. Acceptable results include
acceleration of fetal heart rate or no change in fetal heart baseline
during a contraction. Unacceptable results include deceleration of
fetal heart rate during a contraction
• The OCT is used to evaluate the high-risk pregnancy where the
placental compromise is suspected.it is often applied to the same
high-risk patients listed under NST. In addition, it is used to evaluate
the patient when a suspicious result is obtained on an NST.The OCT
is more invasive than NST

43. • BREAST STIMULATION TEST(BST)
• This test involves stimulation of the nipples (by rubbing),
which causes the posterior pituitary to release the hormone oxytocin,
which in turn causes contraction.

44. 6) ULTRASONOGRAPHY
• IUGR can be diagnosed accurately with serial measurement of BPD,
AC, HC, FL and amniotic fluid volume.AC is the single measurement
which best reflects fetal nutrition. The average increase of biparietal
diameter beyond 34 weeks is 1.7 mm per week. When HC/AC ratio is
elevated (>1.0) after 34 weeks, IUGR suspected. Ultrasound
examination is the main diagnostic tool to assess fetal growth.

45. 7) DOPPLER ULTRASONOGRAPHY
• A fetal doppler is an ultrasound scan that helps assess the baby’s
growth and blood flow to different parts of the baby’s body including
the umbilical cord, brain and heart.it helps to study whether sufficient
oxygen and nutrients that the child needs are being supplied via the
placenta.

46. 8)VIBROACOUSTIC STIMULATION TEST
• Fetal vibroacoustic stimulation is a simple, non-invasive technique
where a device is placed on the maternal abdomen over the region of the
feta head and sound is emitted at a predetermined level for several
seconds. It is hypothesised that the resultant startle reflex in the fetus
and the subsequent heart rate acceleration or transient tachycardia
following VAS provide reassurance of fetal wellbeing.

47. • CONCLUSION
• The biophysical profile is a non-invasive prenatal diagnostic test that
usually is performed after the 28th weeks of pregnancy to evaluate the
well being of the fetus.it combines an ultrasound examination with a
nonstress test.it cause minimal risk to the fetus and expectant mother.it
has lower reliability if the fetus is severely premature. results may be
affected by use of corticosteroids. The test may need to be done in some
cases.

48. • BIBLIOGRAPHY
• DC DUTTA’S Text book of obstetrics 7 revised edition
• NIMA BHASKAR Midwifery and obstetrical nursing third edition