biophysical profile
{{short description|Prenatal ultrasound evaluation of fetal well-being}}
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| purpose =prenatal evaluation ultrasound
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| synonyms = BPP
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A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system,{{Cite journal|last1=Lalor|first1=J. G.|last2=Fawole|first2=B.|last3=Alfirevic|first3=Z.|last4=Devane|first4=D.|date=2008-01-23|title=Biophysical profile for fetal assessment in high risk pregnancies|journal=The Cochrane Database of Systematic Reviews|volume=2008 |issue=1|pages=CD000038|doi=10.1002/14651858.CD000038.pub2|issn=1469-493X|pmid=18253968|pmc=7052779}} with the score being termed Manning's score.[https://books.google.com/books?id=SsKy_YA2tmwC&pg=PA215 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 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 five components: four ultrasound (US) assessments and an NST. The NST evaluates fetal heart rate and response to fetal movement. The five discrete biophysical variables are:
- Fetal heart rate
- Fetal breathing
- Fetal movement
- Fetal tone
- Amniotic fluid volume
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! 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{{cite web |url=http://emedicine.medscape.com/article/405454-overview |title=Biophysical Profile, Ultrasound: eMedicine Radiology |access-date=2009-12-29}} in 30 minutes |
| US: Fetal activity / gross body movements
|At least three discrete body/limb movement in 30 minutes (episodes of active continuous movement considered a single movement. |
| US: Fetal muscle tone
|At least one episode of active extension with return to flexion of fetal limb(s) or trunk, opening and closing of hand considered to be normal tone. |Either slow extension with return to partial flexion or movement of limb in full extension or absent fetal movement. |
| US: Qualitative AFV/AFI
|At least one vertical pocket > 2 cm in the vertical axis or AFI of 5 cm |Largest vertical pocket |
Use of vibroacoustic stimulation to accelerate evaluation has been described.{{cite journal |vauthors=Pinette MG, Blackstone J, Wax JR, Cartin A |title=Using fetal acoustic stimulation to shorten the biophysical profile |journal=J Clin Ultrasound |volume=33 |issue=5 |pages=223–5 |date=June 2005 |pmid=16047387 |doi=10.1002/jcu.20116|s2cid=32503466 }}
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.{{Cite journal |last=Mari |first=Etwell |date=2018-04-17 |title=Decreased Fetal Movements are an Important Red Flag in Second Half of Pregnancy: A Case Report of Baby Saved by Mother's Attention to Fetal Movements |journal=Current Opinion in Gynecology and Obstetrics |volume=1 |issue=1 |pages=21–27 |doi=10.18314/cogo.v1i1.862 |issn=2637-4617|doi-access=free |s2cid=59490398 }}
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.
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| BPP | Recommended management |
|---|---|
| ≤2
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| 4
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| 6
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| ≥ 8
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