Biophysical profile

1. BIOPHYSICAL PROFILE
Presented by Dr Theophile HAVUGIMANA, PG Y III
Supervisor: Dr Eugene NGABONZIZA
College of Medicine and Health sciences School of Medicine

2. WHAT IS A BPP
 A NONINVASIVE PROCEDURE FOR EVALUATING THE FETUS FOR
SIGNS OF COMPROMISE.
 ULTRASOUND USED FOR ASSESSING : FETAL MOVEMENT, FETAL
TONE, FETAL BREATHING, AND AMNIOTIC FLUID VOLUME
 A SEPARATE NONSTRESS TEST OF THE FETAL HEART RATE CAN
ALSO BE PERFORMED WITH A CTG AS A COMPONENT OF BPP.

3. BPP
 PREGESTATIONAL DIABETES MELLITUS
 HYPERTENSION
 SYSTEMIC LUPUS ERYTHEMATOSUS
 CHRONIC RENAL DISEASE
 ANTIPHOSPHOLIPID SYNDROME
 HYPERTHYROIDISM (POORLY CONTROLLED)
 HEMOGLOBINOPATHIES (SICKLE CELL, THALASSEMIA DISEASE)
 CYANOTIC HEART DISEASE

4. PREGNANCY-RELATED INDICATIONS OF BPP
GESTATIONAL HYPERTENSION / PREECLAMPSIA
 DECREASED FETAL MOVEMENT
 GDM (POORLY CONTROLLED OR MEDICALLY TREATED)
 OLIGOHYDRAMNIOS
 FETAL GROWTH RESTRICTION
 LATE TERM OR POSTTERM PREGNANCY
 ISOIMMUNIZATION
PREVIOUS FETAL DEMISE (UNEXPLAINED OR RECURRENT RISK)
MONOCHORIONIC MULTIPLE GESTATION (WITH SIGNIFICANT
GROWTH DISCREPANCY
ANEMIA ON PREGNANCY

5. FIVE COMPONENTS OF BPP
1. FETAL BREATHING MOVEMENTS: AT LEAST ONE FETAL
BREATHING MOVEMENTS OF 30 SECONDS OR MORE WITHIN 30
MINUTES
2. FETAL MOVEMENT: THREE OR MORE DISCRETE BODY OR LIMB
MOVEMENTS WITHIN 30 MINUTES
3. FETAL TONE: ONE OR MORE EPISODES OF EXTENSION OF A FETAL
EXTREMITY WITH RETURN TO FLEXION, OR OPENING OR CLOSING OF
A HAND
4. DETERMINATION OF THE AMNIOTIC FLUID VOLUME: A SINGLE
DEEPEST VERTICAL POCKET GREATER THAN 2 CM
5. NONSTRESS TEST: MAY BE OMITTED WITHOUT COMPROMISING

6. BPP SCORING
EACH OF THE FIVE COMPONENTS IS ASSIGNED A
SCORE OF EITHER 2 IF PRESENT OR IF ABSENT
A COMPOSITE SCORE OF 8 OR 10 IS NORMAL,
A SCORE OF 6 IS CONSIDERED EQUIVOCAL,
A SCORE OF 4 OR LESS IS ABNORMAL.
REGARDLESS OF THE BPP SCORE,
OLIGOHYDRAMNIOS MVP <2 CM OR SHOULD

7. HYPOXEMIA AND BPP CHANGES
ACUTE FETAL BIOPHYSICAL ACTIVITIES RESPOND TO HYPOXEMIA IN
A PREDICTABLE, PHYSIOLOGICALLY BASED CASCADE:
LOSS OF FETAL BREATHING MOVEMENTS AND FETAL HEART RATE
ACCELERATIONS,
FOLLOWED BY DECREASED FETAL MOVEMENT,
FINALLY LOSS OF FETAL TONE.
THIS SEQUENCE IS OF CLINICAL VALUE SINCE IT ALLOWS FOR
ESTIMATION OF BOTH THE PRESENCE AND SEVERITY OF HYPOXEMIA.

8. SIGNIFICANCE OF CHANGES IN AMNIOTIC VOLUME
FETAL URINE IS THE PREDOMINANT SOURCE OF AMNIOTIC FLUID
AFTER ABOUT 16 WEEKS OF GESTATION.
 SELECTIVE REDISTRIBUTION OF ITS CARDIAC OUTPUT, WITH
PREFERENTIAL FLOW DIRECTED TO THE BRAIN, HEART, ADRENALS,
AND PLACENTA AT THE EXPENSE OF ALL OTHER ORGAN SYSTEMS.
KIDNEY EXCLUDED
 IT TAKES APPROXIMATELY 15 DAYS FOR A FETUS TO PROGRESS
FROM NORMAL TO REDUCED AMNIOTIC FLUID VOLUME (IN THE
ABSENCE OF MEMBRANE RUPTURE) AND 23 DAYS TO DEVELOP

9. DURATION OF FETAL OBSERVATION
THE AVERAGE TIME TO OBTAIN A NORMAL BPP SCORE
(BPP 10/10, 8/8) IS 5.3 MINUTES, BUT CAN TAKE UP TO 30
MINUTES.
TO CONFIRM A BPP IS EQUIVOCAL (6/10) OR WORSE (≤4/10) WILL
ALWAYS REQUIRE 30 MINUTES OF OBSERVATION.
WHEN ALL TESTS ARE CONSIDERED (NORMAL, EQUIVOCAL,
ABNORMAL) THE AVERAGE TESTING TIME IS ABOUT 18 MINUTES
 TAKE AT LEAST 30 MINUTES BEFORE ASSIGNING AN ACUTE
PARAMETER 0 POINTS
A NONSTRESS TEST SHOULD ALWAYS BE PERFORMED IF ANY
ULTRASOUND MONITORED PARAMETER IS 0 (IE, BPP ≤6/8).

10. MODIFIED BIOPHYSICAL PROFILE
 SIMPLIFY THE EXAMINATION AND REDUCE THE TIME NECESSARY
TO COMPLETE TESTING
FOCUS ON THOSE COMPONENTS OF THE BPP THAT ARE MOST
PREDICTIVE OF OUTCOME:
NONSTRESS TEST AND AMNIOTIC FLUID VOLUME.
RELIABLE PREDICTOR OF LONG-TERM FETAL WELL-BEING AS THE
FULL BPP.
THE RATE OF STILLBIRTH WITHIN ONE WEEK OF A NORMAL
MODIFIED BPP IS THE SAME AS WITH THE FULL BPP: 0.8 PER 1000
WOMEN TESTED.

11. INTERPRETATION
 10/10, 8/8 (NST OMITTED), OR 8/10 (-2 POINTS FOR EITHER FETAL
MOVEMENT, TONE, OR BREATHING BUT NOT AMNIOTIC FLUID): NORMAL RISK
OF IUFD 0.4 TO 0.6/1000 BIRTHS.
6/10 (-4 POINTS FOR TWO OF FETAL MOVEMENT, TONE, BREATHING, BUT
+2 POINTS FOR AMNIOTIC FLUID: EQUIVOCAL TEST RESULT. THE TEST IS
REPEATED WITHIN 24 HOURS TO SEE IF ONE OF THE ABSENT ACUTE
VARIABLES RETURNS TO NORMAL OR, IF THE PATIENT IS AT OR NEAR TERM,
DELIVERY IS A REASONABLE OPTION.
6/10 OR 8/10 WITH 0 POINTS FOR AMNIOTIC FLUID IS AN ABNORMAL TEST,
AS THE RISK OF FETAL ASPHYXIA WITHIN ONE WEEK IS 89/1000 WITH
EXPECTANT MANAGEMENT.
0 TO 4/10 IS ABNORMAL; THE RISK OF FETAL ASPHYXIA WITHIN ONE WEEK
IS 91 TO 600/1000 IF THERE IS NO INTERVENTION. DELIVERY IS USUALLY

12. FACTORS POTENTIALLY AFFECTING THE SCORE
 .
Factor Effect Duration
Antenatal
corticosteroids
-Decrease in variability on days
2 and 3 after administration
-Reduced Fetal breathing and
body movements
Return to baseline by
day 4 after treatment
Preterm labor Absence of fetal breathing
movements
-
Fasting Reduced NST, breathing -

13. INITIATION AND FREQUENCY OF BPP TESTING
INITIATION: BEGIN AS SOON AS AN INCREASED RISK OF FETAL DEMISE IS
IDENTIFIED AND DELIVERY FOR PERINATAL BENEFIT WOULD BE CONSIDERED IF
TEST RESULTS ARE ABNORMAL. THIS MAY BE AS EARLY AS 24 WEEKS OF
GESTATION.
INITIATING ANTEPARTUM FETAL TESTING NO EARLIER THAN 32 0/7 WEEKS
OF GESTATION IS APPROPRIATE FOR MOST AT-RISK PATIENTS
FREQUENCY: A NORMAL BPP SCORE (10/10 OR 8/10 WITHOUT
OLIGOHYDRAMNIOS) IS REPEATED WEEKLY OR TWICE WEEKLY UNTIL DELIVERY
WHEN THE HIGH-RISK CONDITION PERSISTS AND APPEARS STABLE.
ANY SIGNIFICANT DETERIORATION IN THE CLINICAL STATUS (EG,
WORSENING PREECLAMPSIA, DECREASED FETAL ACTIVITY) REQUIRES
REEVALUATION, REGARDLESS OF THE AMOUNT OF TIME ELAPSED SINCE THE
LAST TEST.

14. COMPONENTS AND SCORES FOR THE
BIOPHYSICAL PROFILE

15. BIOPHYSICAL PROFILE SCORE NTERPRETATION

16. REFERENCE
1. WILLIAMS OBSTETRICS 25 EDITION
2. UPTODATE
3. ANTEPARTUM FETAL SURVEILLANCE, PRACTICE BULLETIN
NO. 229. (JUNE, 2021). OBSTETRICS & GYNECOLOGY,
124(1), 182–192.
4. PERINATOLOGY, (2021). , BIOPHYSICAL PROFILE AVAILABLE AT:
HTTPS://WWW.PERINATOLOGY.COM/REFERENCE/GLOSSARY/B/BIOPHYSICAL%20
PROFILE.HTM , ACCESSED ON 09/09/2021