014 the Fetal Biophysical Profile

7/11/2014 The fetal biophysical profile

http://www.uptodate.com/contents/the-fetal-biophysical-profile?topicKey=OBGYN%2F5392&elapsedTimeMs=0&source=search_result&searchTerm=bi 1/15

Official reprint from UpToDate www.uptodate.com 2014 UpToDate

AuthorFrank A Manning, MD

Section EditorCharles J Lockwood, MD,MHCM

Deputy EditorVanessa A Barss, MD,FACOG

The fetal biophysical profile

All topics are updated as new evidence becomes available and our peer review process is complete.Literature review current through: Oct 2014. | This topic last updated: Aug 12, 2013.

INTRODUCTION The fetal biophysical profile score (BPS or BPP) refers to the sonographic assessment offour discrete biophysical variables:

Fetal movementFetal toneFetal breathingAmniotic fluid volumeResults of nonstress testing

Each of these five parameters is given a score of 0 or 2 points, depending upon whether specific criteria aremet (table 1). The presence of these biophysical variables implies absence of significant central nervoussystem hypoxemia/acidemia at the time of testing. By comparison, a compromised fetus typically exhibits lossof accelerations of the fetal heart rate (FHR), decreased body and breathing movements, hypotonia, and, lessacutely, decreased amniotic fluid volume.

The clinical value of the cumulative fetal BPS is that it is noninvasive, easily learned and performed, and anaccurate means for predicting the presence of significant fetal acidemia, which is the most common cause offetal death or damage [1]. Seventy to 90 percent of late fetal deaths display evidence of chronic or acute andchronic compromise prior to demise [2]. Sonographic detection of signs of fetal compromise can allowappropriate intervention that ideally will prevent adverse fetal sequelae.

Although the use of biophysical testing schemes to monitor high-risk pregnancies has become routine, thispractice pattern has evolved with limited high quality scientific data to support its use [3]. Moreover, there areno randomized trials on which to base recommendations for the best initial testing approach for specific typesof high-risk pregnancies, the optimal timing of test initiation, the frequency of testing based on test results,conditions that may affect test results, and the effect of gestational age.

ONTOGENY OF FETAL BIOPHYSICAL REGULATION The ontogeny of fetal biophysical developmentfollows a rigidly prescribed course. The initial step is cell differentiation, whereby cells acquire their uniquecharacteristics. Differentiation and functional capacity usually occur nearly simultaneously. Specific functionalentities develop as individual cells begin to interact with each other and come under local regulation. As theybecome enervated, these functional entities progressively come under the control of local, then regional, andfinally central neuronal regulation. All biophysical activities are eventually regulated and controlled by discretecenters within the brain. The individual neurons within a given regulatory site always retain their sensitivity tolocal factors; however, they are also sensitive and responsive to feedback from peripheral sensors and totraffic generated within the brain. Modulating brain traffic first manifests as short sleep-wake cycles, thenprogresses to circadian cycles, and finally to consciousness cycles.

The following principles derive from this ontogeny and are the basis for fetal biophysical monitoring:

Any given biophysical variable reflects the integration of signals arising within the central nervoussystem. The presence of normally organized biophysical activity is reliable, presumptive evidence thatthe central nervous system is intact and not affected by pathological modulation.



Neurons, with their high metabolic rate and demand, are exquisitely sensitive to local hypoxemia andischemia. Pathological suppression of the neurons composing a given regulatory site due to hypoxemiaresults in loss of the normal features of a given biophysical activity.

However, the absence or diminution of a given biophysical variable does not necessarily meanpathology is present. Normal suppression of a regulatory center can occur from intrinsic fetal rhythms,such as the deep stage of quiet sleep, or the presence of circulating agents that cause generalsuppression of the brain, such as transplacental passage of maternal sedatives and opiates.

Progressive loss of brain regulation of biophysical activities results in regression to regional control andultimately to local control (reverse ontogeny).

BIOPHYSICAL VARIABLES USED IN FETAL MONITORING The fetal BPS is derived from assessmentof five discrete biophysical variables (table 1), which are regulated by discrete higher central nervous systemcenters. Four of these parameters: FHR accelerations in response to fetal movements (nonstress test), fetalbreathing movements, generalized fetal movements, and fetal tone are acute variables since they are acutelyaffected by perturbations in fetal oxygenation.

Acute variables The selection of the acute variables for the fetal BPS was based upon their ease ofmeasurement and the ability to objectively evaluate them using universally available equipment (eg, externalFHR monitors and ultrasound imaging). Other fetal biophysical activities (eg, sucking, swallowing, micturition,eye movements) may serve equally well as markers of fetal health, but are not included because measurementis difficult and may be subjective.

Each of the acute variables can be viewed as an indirect assessment of the integrity of the regulatory centersince each acts as a peripheral transducer of central nervous system regulatory output. When a given variableis observed to be normal (eg, fetal breathing movements), the integrity of the regulatory center is ensured andthe presence of a pathological factor, such as hypoxemia or acidemia, can be reliably excluded. In contrast,when a given acute variable is not normal, a differential diagnosis is always required. The most commoninnocuous cause of absence of a given acute variable is fetal state change and, most commonly, quiet sleep.Since the sensitivity to depth and duration of quiet sleep varies by discrete regulatory center, it is unusual toobserve the absence of two or more variables as a consequence of quiet sleep alone. Extending theobservation period to encompass the usual duration of sleep state cycles minimizes the possibility of confusionof pathological versus physiological causes of absent variable. The more variables are absent (ie, the lower thescore), the less likely the change is due to sleep state. Similarly, the longer the absence of variables, the morelikely the cause is due to a pathological influence.

The acute variables function to enhance fetal development, but are not essential to maintaining fetal life, thusthey are expendable in times of stress since they are energy dependent and increase fetal oxygenrequirements. As an example, pharmacological paralysis of sheep fetuses to prevent fetal movement results inan abrupt fall in oxygen consumption by as much as 20 percent and a rise in fetal PO2 by as much as 15percent [4]. Similarly in the human fetus, administration of a short acting curare (eg, pancuronium) to preventfetal movement produces an immediate rise in fetal venous PO2 by as much as 30 percent [5].

The degree of fall in oxygen concentration necessary to abolish a given regulatory center output varies bycenter. The most oxygen sensitive centers are the cardioregulatory neurons controlling the coupling of fetalmovement and heart rate acceleration, and the fetal breathing center neurons. The centers regulating fetalmovement have a higher threshold than those for fetal breathing or FHR accelerations; the fetal tone centerhas the highest threshold. Thus, the acute fetal variables respond to hypoxemia in a predictable,physiologically based cascade: loss of fetal breathing movements and FHR acceleration, followed bydecreased fetal movement, and finally loss of fetal tone. This phenomenon is of great clinical value since itallows for estimation of both the presence and severity of hypoxemia.

The threshold of the various regulatory centers is not absolute, but can adjust over time. This effect is likely aresult of adaptive response, which increases local oxygen supply, rather than the result of a true change inneuron oxygen requirements. Such compensatory responses include increased oxygen extraction, elevatedfetal hemoglobin with increased oxygen carrying capacity, and redistribution of blood flow to favor brain



perfusion. In some chronic fetal conditions, the acute biophysical variables may initially disappear and thenreappear despite a low P02.

The relationship between significant fetal acidemia and low BPS was inferred because the BPS was firstdescribed before it was possible to obtain antepartum fetal blood. Perinatal mortality (gross and corrected) andserious perinatal morbidity (nonreassuring FHR tracing in labor, low Apgar scores, neonatal seizures,admission to an intensive care unit, hypoxemic-ischemic encephalopathy, intrauterine growth restriction)increased significantly as the last BPS fell (figure 1) [6-8]. In addition, the cord blood pH of infants deliveredeither vaginally or by cesarean birth demonstrated a direct relationship to last BPS (figure 2) [9]. An inverserelationship between last BPS and incidence of cerebral palsy has also been observed, and may or may not berelated to antepartum asphyxia (figure 3). Long-term asphyxia leading to adverse neurologic outcomes such ascerebral palsy and intellectual disability appears to be significantly reduced in high-risk patients managed byfetal biophysical profile scoring compared to untested low-risk patients [10].

The advent of ultrasound guided intrauterine fetal blood sampling (cordocentesis) made it possible to measurethe direct and immediate relationship between the BPS, fetal PO2, and fetal pH [11,12]. (See "Fetal bloodsampling".) These studies, which include over 1000 paired observations, indicate a significant directrelationship between the BPS and mean umbilical venous pH and further demonstrate that, in the individualfetus, the BPS accurately predicts both the probability and severity of existing acidemia [13,14]. Thus, thescore is an accurate proxy for fetal acidosis. By comparison, the relationship between the BPS and fetal P02 isless precise. This is expected since P02 varies according to fetal compensatory adaptive responses.

Chronic variable The fifth variable of the fetal BPS is amniotic fluid volume. Fetal urine is the predominantsource of amniotic fluid from approximately the mid-second trimester (16 weeks). Fetal urine production isprimarily dependent upon renal perfusion, which in turn reflects selective distribution of cardiac output. Thefetus responds to sustained hypoxemia (asphyxia) by selective redistribution of its cardiac output, withpreferential flow directed to the brain, heart, adrenals, and placenta at the expense of all other organ systems[15]. (See "Physiology of amniotic fluid volume regulation".)

This protective mechanism is reflex in origin and is initiated by specialized chemoreceptors in the aortic archand carotid arteries. Hypoxemia-induced reflex redistribution of cardiac output results in diminished fetal urineproduction [16]. Fetal swallowing, a major mechanism for removal of amniotic fluid, is a vegetative reflex andvery resistant to the effects of hypoxemia. Therefore, the net effect of decreased urine production is a gradualreduction in the amount of amniotic fluid, ultimately leading to oligohydramnios and then anhydramnios.

The time course for the evolution of oligohydramnios is usually relatively long. On average, it takesapproximately 15 days for a fetus to progress from normal to reduced amniotic fluid volume (in the absence ofmembrane rupture) and 23 days to develop severe oligohydramnios [16]. However, acute changes in amnioticfluid volume with rapid deterioration of the BPS have been reported [17].

It is also important to recognize that the fetal effects of hypoxia-induced redistribution of cardiac output are notconfined to the fetal kidney. Other signs of chronic hypoxemia presenting in the fetus and newborn, such asreduced fetal growth with brain sparing, can be attributed to effects from the compensatory cardiovascularreflex response.

BIOPHYSICAL SCORE

Determination The composite fetal BPS is derived from five variables: four acute variables (FHRaccelerations in response to fetal movements [nonstress test], fetal breathing movements, generalized fetalmovements, fetal tone) and one chronic variable (amniotic fluid volume). Each of these five variables havebeen evaluated independently and the normal characteristic defined (table 1) [18]. The scoring method used foreach variable is binary, ie, the variable is either normal or abnormal; gradations of abnormality are not used. Anormal variable is assigned a score of two and an abnormal variable a score of zero. The maximal score is10/10 and the minimum score is 0/10.

A variable may be assigned a normal score as soon as it is observed. Since most fetuses will be normal andwill demonstrate these biophysical activities, the usual time to complete a normal fetal BPS is less than fiveminutes [19]. The acute variables are subject to fetal sleep wake cycles; thus, continuous observation for at



least 30 minutes must occur before the variable can be defined as absent (abnormal). In one ultrasound studyof fetuses from uncomplicated pregnancies at 36 to 42 weeks of gestation, the mean duration of a fetal sleep(no somatic movements) was about 20 minutes, with an upper range of about 40 minutes [20].

The variables should be present and normal biophysical activities to be assigned a score of two. As anexample, monotonous picket-fence breathing or gasping should not be considered normal breathing movementsnor should seizures be counted as normal fetal limb movements [21-23].

We generally base evaluation of amniotic fluid volume on ultrasound measurement of the largest visible pocket.To score 2 points, the selected largest pocket must have a transverse diameter of at least 1 centimeter and avertical pocket of at least 2 centimeters. However, other methods of amniotic fluid volume assessment can beused (eg, normal amniotic fluid index is 5 to 25 cm, normal single deepest vertical pocket is 2.1 to 8 cm). (See"Assessment of amniotic fluid volume".) There is a significant inverse relationship between oligohydramniosand perinatal mortality and morbidity. (See "Oligohydramnios", section on 'Prognosis and management'.)

Modified biophysical profile The modified biophysical profile was developed to simplify the examinationand reduce the time necessary to complete testing by focusing on those components of the profile that aremost predictive of outcome. Assessment of amniotic fluid volume and nonstress testing appears to be asreliable a predictor of long-term fetal well-being as the full BPS [24]. A normal modified biophysical profile willoccur in 90 percent of pregnancies tested, thus it is necessary to proceed with a full biophysical evaluation inonly a minority of patients [25]. The rate of stillbirth within one week of a normal test is the same as with thefull BPS, 0.8 per 1000 women tested [25].

Factors affecting test results Administration of antenatal corticosteroids can be associated with transientFHR and behavioral changes that typically return to baseline by day four after treatment. The most consistentFHR finding is a decrease in variability on days two and three [26-29]. Fetal breathing and body movementsare also commonly reduced, which may result in a lower biophysical profile score or nonreactive nonstress test[30-34]. However, fetal blood flow velocity waveform patterns in the umbilical artery, middle cerebral artery,and ductus venosus do not appear to be affected [31,34,35].

The behavioral changes may reflect a physiologic response of the brain to glucocorticoids. Alternatively, theymay be a consequence of a transient increase in fetal vascular resistance and blood pressure, which has beendemonstrated in animal studies [35-37]. These findings should be considered within the total clinical picturewhen assessing a fetus for possible delivery because of a nonreassuring fetal evaluation (nonstress test orbiophysical profile) after corticosteroid administration.

The effect of subclinical infection on test results is controversial. Although the BPS is used to diagnose fetalinfection or chorioamnionitis [38], most studies have not found it to be a very sensitive test of subclinicalinfection [39-42]. (See "Preterm premature (prelabor) rupture of membranes".)

Preterm labor may be associated with absence of fetal breathing movements. However, a systematic reviewfound that data were inadequate to recommend monitoring fetal breathing for prediction of preterm deliverywithin 48 hours or seven days [43].

There are sparse data on the effect of fasting on BPS. A study that performed a BPS one hour after a meal and10 to 12 hours after abstaining from food and drink in 30 women with uncomplicated pregnancies reportedscores of 8/10 for all postprandial tests, but two fasting tests were 4/10 and 6/10; both tests rose to 10/10after the mother ate a meal [44]. Point reductions during fasting were primarily due to non-reactive NSTs andinadequate fetal breathing movements. It is difficult to draw any conclusion about the effect of fasting on theBPS in the clinical setting, given the small size of this study and the absence of indications for antepartumfetal assessment.

Mild maternal anemia (mean hemoglobin 9.4 g/dL) did not appear to affect the BPS [45].

INTERPRETATION, MANAGEMENT, OUTCOME BPS results are interpreted as follows:

10/10 or 8/10 (includes 2 points for amniotic fluid): risk of developing fetal asphyxia within one week ifno intervention is low (about 1/1000).



6 or 8/10 (0 points for amniotic fluid): when amniotic fluid volume is decreased, the risk of developingfetal asphyxia within one week if no intervention is increased at 89/1000.

6/10 (includes 2 points for amniotic fluid): equivocal test, significant possibility of developing fetalasphyxia cannot be excluded. Repeat test within 24 hours to see if one of the absent acute variablesreturns to normal or deliver if at or near term.

0 to 4/10: risk of fetal asphyxia within one week if no intervention is 91 to 600/1000. Delivery is usuallyindicated. The mode of delivery is an obstetric decision based on multiple variables includingpresentation, cervical findings and maternal condition. In the absence of obstetric contraindication,induction of labor with continuous intrapartum fetal heart surveillance is a reasonable managementoption.

The predictive value of the four ultrasound-monitored variables for assurance of fetal well-being is equivalent tothat of a full BPS (four ultrasound variables and nonstress test) when the four variables are all normal. Thiswas illustrated in a prospective study in which the nonstress test (NST) was only performed if the ultrasoundscore was less than 8 [46]. This modification reduced the need for NSTs in 95 percent of cases and theaverage testing time per patient without reducing the predictive value of the test.

An NST should always be performed if any ultrasound monitored variable is 0. However, a BPS of 8/10 by anycombination of variables with or without the NST is as accurate as a score of 10/10 for the prediction of fetalwell-being as long as no points are deducted for amniotic fluid volume (eg, FM+FB+FT+AVF=8 orFM+FT+AVF+NST=8, where FM=fetal movement, FB=fetal breathing, FT=fetal tone, AVF=amniotic fluidvolume).

Although outcome data from large randomized studies are lacking [47], observational studies have reported it tobe accurate for predicting the absence of significant fetal acidemia [48] and comparable to the contractionstress test [49].

The probability of fetal acidemia is virtually nil when the score is normal (10 or 8 without oligohydramnios); thelikelihood of fetal compromise and death rises as the cumulative score falls. The false negative rate (ie, fetaldeath within one week of a last test with a normal score) is not zero, but is exceedingly low (0.4 to 0.6 per1000 live births) and is approximately 10 percent of the overall perinatal mortality for a high-risk population [50].False-negatives are likely due to acute insults such as sudden cord prolapse, fetomaternal hemorrhage, orabruptio placenta.

The utility of biophysical fetal monitoring was demonstrated in a study of 44,828 biophysical profile tests inwhich the risk of fetal demise within one week of a normal test result (corrected for lethal congenital anomaliesand unpredictable causes of demise) was 0.8 per 1000 women tested [50]. This result compares favorably withall other means of antepartum fetal assessment. In two large observational studies including over 18,000women, use of the BPS was associated with a 61 to 76 percent reduction in perinatal mortality (corrected)compared to historic controls [51].

However, the positive predictive value of the BPS for evidence of true fetal compromise (eg, a non-reassuringfetal heart tracing during labor, neonatal acidemia, or other markers of neonatal morbidity at the time ofdelivery) is only approximately 50 percent, with a negative predictive value greater than 99.9 percent.Therefore, it is important that the a priori risk of fetal compromise be elevated to improve the performance of apositive test result.

The fetal BPS reaches maximal clinical efficacy when interpreted within the context of fetal age and maternaland obstetric factors. As an example, a normal score predicts no fetal compromise and allows for conservativemanagement in a gravida with discrete high risk factors, such as diabetes mellitus or hypertension. Thisaffords the fetus the advantage of continued intrauterine maturation and thereby reduces the risk ofcomplications from prematurity. In contrast, an abnormal score in a similar high risk patient allows for weighingof relative fetal-to-neonatal risks and selection of delivery at a time when the balance shifts to greater fetal risk(figure 4).

A change in maternal condition will also affect application of the fetal BPS. The decision to intervene in a



patient with worsening hypertension, for example, may depend less on the score and more on maternal risk.Similarly, the presence of a favorable cervix for induction may override the results of the BPS when the fetus ismature or postterm.

Case reports and small series suggest that the BPS is less reliable in pregnancies complicated by severepreterm fetal growth restriction. As an example, in one study, 48 growth restricted fetuses less than 32 weeksof gestation with abnormal umbilical artery Doppler results underwent BPS daily and NSTs three times daily[52]. Ten of 27 fetuses with BPS of 8 developed nonreassuring fetal tracings 3.5 to 24 hours after the BPS andthe repeat BPS was 2 in all 10 of these fetuses; three died in utero, seven were delivered promptly and six ofthese neonates had acidemic umbilical artery blood gases at birth.

INDICATIONS AND FREQUENCY OF TESTING The American College of Obstetricians andGynecologists (ACOG) recommends antepartum fetal surveillance of pregnancies in which the risk ofantepartum fetal demise is increased [53]. An ACOG Practice Bulletin states that women with high-risk factorsfor significant fetal acidemia should undergo antepartum fetal surveillance with tests such as the BPS andnonstress test. Specific indications for antenatal fetal assessment are reviewed separately. (See "Overview ofantepartum fetal surveillance", section on 'Indications for fetal surveillance'.)

All of the ultrasound-monitored variables for the BPS can be observed as early as the first trimester, althoughcharacteristics of fetal behavior (breathing, tone, movement, as well as other fetal activities) change withadvancing gestational age [54,55]. The minimum gestational age for testing should reflect the lower limit thatintervention with delivery would be considered. This age has gradually decreased and is now 24 to 25 weeks inmost centers. Testing may be initiated at this gestational age if clinical conditions suggest early fetalcompromise is likely; otherwise, testing is initiated when individual clinical circumstances warrant fetalmonitoring. Initiating testing at 32 to 34 weeks of gestation is appropriate for most pregnancies at increasedrisk of stillbirth.

A reassuring BPS (eg, BPS of 8 to 10) should be repeated periodically (weekly or twice weekly) until deliverywhen the high-risk condition persists. Some experts recommend more frequent testing intervals, withindividualization based on the high-risk clinical setting (eg, early severe fetal growth restriction) [56]. Anysignificant deterioration in the clinical status (eg, worsening preeclampsia, decreased fetal activity) requiresfetal reevaluation, regardless of the amount of time elapsed since the last test.

Normal antepartum testing does not preclude the need for intrapartum fetal monitoring. Induction of labor maybe attempted with abnormal antepartum testing as long as the FHR and contractions are monitoredcontinuously and are reassuring. Cesarean delivery is indicated if there are repetitive late decelerations.

Although the BPS test is typically used for antepartum fetal assessment, it can also be done intrapartum.However, its clinical utility in the intrapartum is unclear [57,58].

SUMMARY AND RECOMMENDATIONS

Criteria for the fetal biophysical profile score (BPS) are listed in the table (table 1). (See 'Determination'above.)

The acute variables are subject to fetal sleep wake cycles; thus, continuous observation for at least 30minutes must occur before the variable can be defined as absent. (See 'Determination' above.)

A score of 8 to 10/10 is reassuring of fetal well-being when amniotic fluid is normal; 6 to 8/10 isconcerning when amniotic fluid volume is decreased and requires increased monitoring or delivery, 6/10with normal amniotic fluid volume is an equivocal test result and should be repeated within 24 hours ifthe patient is not delivered; and 0 to 4/10 suggests a high risk of fetal asphyxia within one week if thepatient remains undelivered or no therapeutic intervention is undertaken. (See 'Interpretation,management, outcome' above.)

We recommend monitoring pregnancies at risk of fetal compromise (Grade 1C). We suggest using thebiophysical score for monitoring because it is a noninvasive, easily applied, accurate means forpredicting the presence of significant fetal acidemia. Testing should be performed one or more times per



week, depending upon the clinical situation. (See 'Indications and frequency of testing' above.)

The integration of the BPS into the management of high-risk obstetric patients has been associated witha significant reduction in perinatal mortality. The perinatal mortality in a high-risk patient managedaccording to the fetal BPS is significantly lower than the rate observed in contemporary untested lowrisk patients. (See 'Interpretation, management, outcome' above.)

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experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths. Am JObstet Gynecol 1987; 157:880.

51. Manning FA. Fetal biophysical profile: a critical appraisal. Clin Obstet Gynecol 2002; 45:975.52. Kaur S, Picconi JL, Chadha R, et al. Biophysical profile in the treatment of intrauterine growth-restricted

fetuses who weigh


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GRAPHICS

Criteria for the biophysical profile test

Nonstress test: 2 points if reactive, defined as at least 2 episodes of FHR accelerations of atleast 15 bpm and at least 15 seconds duration from onset to return associated with fetalmovement within a 30-minute observation period.

Fetal breathing movements: 2 points if one or more episodes of rhythmic breathingmovements of 30 seconds within a 30-minute observation period.

Fetal tone: 2 points if one or more episodes of extension of a fetal extremity or fetal spine withreturn to flexion.

Amniotic fluid volume: 2 points if a single pocket of fluid is present measuring at least 2 cmby 1 cm. However, some clinicians use other criteria such as the amniotic fluid index.

Fetal movement: 2 points if three or more discrete body or limb movements within 30minutes of observation. An episode of active continuous movement is counted as onemovement.

0 points are assigned for any criteria not met.

bpm: beats per minute; FHR: fetal heart rate.

Graphic 79813 Version 4.0



Relationship between biophysical profile score and perinatalmortality and morbidity

A) The relationship betwen the fetal biophysical profile score (BPS) result and theoccurance of various perinatal morbidities. The incidence of fetal distress in labor (FD),cesarean section for fetal distress (LSCS-FD), low 5-minute Apgar score, and venous cordblood acidemia exhibit a very significant linear inverse relationship to test score. Thesedata are based on observations made in more than 26,000 high-risk fetuses. B) Therelationship betwen the fetal BPS and perinatal death (PNM), both gross and corrected forfatal anomalies. Unlike morbidity, the mortality rate increases in an inverse exponentialfashion as the BPS score decreases.

Adapted from data published in: Manning, FA. Dynamic ultrasound-based fetal assessment: the fetalbiophysical profile score. Clin obstet Gynecol 1995; 38:26.




The relationship between fetal umbilical venous pH(2 SD) by cordocentesis and the fetal biophysicalprofile score (BPS)

The correlation was linear, inverse, and very significant (R 0.912;p



Inverse relationship between the last fetalbiophysical profile score (BPS) and cerebral palsy(CP)

The relationship between the fetal biophysical profile score and CP isinverse, exponential, and highly significant R = -.096; P



Comparison of neonatal death rates as predictedby gestational age and fetal death rates aspredicted by the fetal biophysical profile (BPS)

The red line represents the probability of neonatal death bygestational age. For example, the risk of fetal death with a BPS of2/10 is approximately 20 percent. Therefore, when the BPS is 2/10,the risk of neonatal death is less than the risk of fetal death if thegestational age is greater than 28 weeks. This graph should be usedfor illustration only because the neonatal survival rate shown herefrom the University of Manitoba may differ from other centers.However, the predictive accuracy of the BPS is unlikely to vary amongcenters.

Adapted from data published in: Manning, FA. Dynamic ultrasound-based fetalassessment: the fetal biophysical profile score. Clin obstet Gynecol 1995;38:26.




Disclosures: Frank A Manning, MD Nothing to disclose. Charles J Lockwood, MD, MHCM Nothingto disclose. Vanessa A Barss, MD, FACOG Employee of UpToDate, Inc. Equity Ownership/StockOptions: Merck; Pfizer; Abbvie.Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, theseare addressed by vetting through a multi-level review process, and through requirements forreferences to be provided to support the content. Appropriately referenced content is required of allauthors and must conform to UpToDate standards of evidence.Conflict of interest policy

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