Biophysical profile

A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system,with the score being termed Manning's score.

The BPP has 5 components: 4 ultrasound (US) assessments and an NST.

1.Fetal heart rate

2.Fetal breathing

3.Fetal movement

4.Fetal tone

5.Amniotic fluid volume

	Normal (2 points)	(0 points)
NST: FHR	At least two accelerations in 20 minutes	< 2
US: Fetal breath- ing move- ments	At least one episode of > 30s or >20s in 30 minutes	None or <30s or 20s
US: Fetal activity /gross body move- ments	At least three or two movements of the torso or limbs	<3 or 2
US: Fetal muscle tone	At least one episode of active bending and straightening of the limb or trunk	No or slow and
US: AFV/AFI	At least one vertical pocket > 2 cm in the vertical axis or AFI of 5 cm	Largest vertical pocket </= 2 cm, or AFI </= 5 cm

BPP of 8 or 10 is generally considered reassuring

Recommended management based on the biophysical profile 

BPP	Recommended management
≤2	Labor induction
4	*Labor induction if gestational age >32 weeks.  *Repeating test same day if <32 weeks, then delivery if BPP <6
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

     

   

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

NON STRESS TEST (NST)

A nonstress test (NST) is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness. A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions.

*A normal nonstress test will show a baseline fetal heart rate between 110 and 160 beats per minute with moderate variability (5- to 25-interbeat variability) and 2 qualifying accelerations in 20 minutes with no decelerations."

*REACTIVE NST" is defined as the presence of two or more fetal heart rate accelerations within a 20-minute period. Each acceleration must increase the heart rate 15 beats per minute above the baseline rate, and last for at least 15 seconds when the fetus is above 32 weeks' gestation, or 10 beats per minute over 10 seconds when the fetus is at or below 32 weeks' gestation.

*"NON-REACTIVE NST" is defined as fewer than two adequate accelerations during a prolonged period, which may be over an hour

Amniotic fluid index (AFI)

(AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. It is a part of the biophysical profile.

AFI is the score (expressed in cm) given to the amount of amniotic fluid seen on ultrasonography of a pregnant uterus. To determine the AFI, doctors may use a four-quadrant technique when the deepest, unobstructed, vertical length of each pocket of fluid is measured in each quadrant and then added up to the others, or the so-called "Single Deepest Pocket" technique.

*An AFI between 8-18 is considered normal. Median AFI level is approximately 14 from week 20 to week 35, when the amniotic fluid begins to reduce in preparation for birth.

*An AFI < 5-6 is considered as oligohydramnios.

*An AFI > 24-25 is considered as polyhydramnios.

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Related Topic

CST

A contraction stress test (CST) is performed near the end of pregnancy (34 weeks' gestation) to determine how well the fetus will cope with the contractions of childbirth. The aim is to induce contractions either nipple stimulation or IV pitocin (oxytocin) and monitor the fetus to check for heart rate abnormalities using a cardiotocograph.

*Negative result is highly predictive of fetal wellbeing and tolerance of labor. 

*A positive CST indicates high risk of fetal death due to hypoxia