“BIOPHYSICAL PROFILE”

““BIOPHYSICAL PROFILE”BIOPHYSICAL PROFILE”

Dr Seyed Asadollah KalantariDr Seyed Asadollah KalantariOB & GynecologistOB & Gynecologist

Isfahan Fertility & Infertility Isfahan Fertility & Infertility CenterCenter

BIOPHYSICAL PROFILE (BPP)BIOPHYSICAL PROFILE (BPP)

• A noninvasive assessment of the fetus and its environment by U/S, noting 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.

parametersparameters Non-Stress Test

Ultrasound

Biophysical profileBiophysical profile• Probability of BPP score being at least 8/10 exceeds

97%– NST probability 85%

• Rate of fetal death within 1 week of normal result 0.4-0.6/1,000 live births

• False positive result depends on score• 6/10 75% FPR• 0/10: almost always indicative of fetal

compromise• Broad range of predictive accuracy

How frequently?How frequently?• Interval should be driven by the requirements

for the test• Should be no more than 7 days• Maybe daily in some critical/unstable

situations – Severe preeclampsia

• Reduction in IUFD with twice-weekly testing– 6.1/1.000 to 1.9/1,000

Maternal and Fetal IndicationsMaternal and Fetal Indications

• APLS• Hyperthyroidism• Hemoglobinopathies• Cyanotic heart disease• SLE• Chronic renal disease• DM 1 and 2

• Hypertensive disorders• Decreased fetal movement• Oligo/polyhydramnios• IUGR• Postterm pregnancy• Isoimmunization

– Moderate to severe• Previous fetal demise

– Unexplained or recurrent risk• Multiple gestation with growth

discordancy

PATHOPHYSIOLOGIC BASIS OF THEPATHOPHYSIOLOGIC BASIS OF THE BIOPHYSICAL PROFILE BIOPHYSICAL PROFILE

• Hypoxemia and acidemia have interference with central nervous system (CNS)

• oligohydramnios with fetal hypoxemia as a result of blood flow redistributed away from the fetal kidneys and viscera in favor of the brain, heart, and adrenal glands.

• When activities of these oxygen-dependent centers are observed, it can be assumed that brain function is normal and systemic hypoxia is not present

• if one or more of the BPP activities is not observed, hypoxemia must be assumed to be the cause of the absence of that activity.

Biophysical Profile Biophysical Profile Variables Variables

• Fetal breathing movements• Gross body movement• Fetal tone• Amniotic fluid volume index• Non-stress test

Basic Physiology & PathoPhysiology ofBasic Physiology & PathoPhysiology of BIOPHYSICAL PROFILE BIOPHYSICAL PROFILE

• Acute Marker Fetal breathing movements Gross body movement Fetal tone Non-stress test • Chronic Marker Amniotic fluid volume index Placental grading

Maturation of Central Nervous System Maturation of Central Nervous System Regulatory CentersRegulatory Centers

ActivityActivity Gestational AgeGestational Ageof Maturationof Maturation((wkwk))

Gross body movementsGross body movements66

Breathing movementsBreathing movements 14141212--

FHR accelerations resulting FHR accelerations resulting from fetal movementfrom fetal movement

18-2018-20

Sleep-wake cyclesSleep-wake cycles 18-2218-22

Integrated behavioral Integrated behavioral patternspatterns

2828

Criteria for Coding Fetal Biophysical Variables as

Normal or Abnormal MeasuremenMeasurementt

Normal Normal

(2 points)(2 points)AbnormalAbnormal

(0 points)(0 points)

Breathing Breathing movement.movement.

1 or more 1 or more breathing breathing movements movements last at least last at least 20 seconds.20 seconds.

Breathing Breathing movement is movement is less than 20 less than 20 seconds or no seconds or no breathing is breathing is observed.observed.

MeasuremenMeasurementt

Normal Normal



Body Body movementsmovements

3 movements 3 movements of the arms, of the arms, legs, or body legs, or body are observed.are observed.

Less than 3 Less than 3 movements movements are observed.are observed.

Criteria for Coding Fetal Biophysical VariablesCriteria for Coding Fetal Biophysical Variables as Normal or Abnormalas Normal or Abnormal

MeasurementMeasurementNormal Normal



Muscle toneMuscle toneand legs are and legs are usually flexed usually flexed and the head and the head rests on the rests on the chest. 1 or chest. 1 or more more extensions extensions and return to and return to flexion are flexion are observed.observed.

Arms and legs Arms and legs are flexed with are flexed with head on chest. head on chest. No extension No extension and flexion is and flexion is observed.observed.


Criteria for Coding Fetal Biophysical Variables Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal as Normal or Abnormal


Normal Normal



Non stress Non stress testtest

test2 or more test2 or more heart rate heart rate increases of increases of 15 beats per 15 beats per minute or minute or more are more are observed observed with with movement. movement.

Only 1 heart Only 1 heart rate increase rate increase is observed or is observed or heart rate heart rate does not does not increase with increase with movement.movement.


Normal Normal



Amniotic Amniotic fluid volumefluid volume

Largest area of fluid Largest area of fluid is greater than 2 cm is greater than 2 cm without containing without containing loops of the umbilical loops of the umbilical cord. Or the amniotic cord. Or the amniotic fluid index (AFI) fluid index (AFI) shows a total of more shows a total of more than 5 cm of fluid in 4 than 5 cm of fluid in 4 areas (4 quadrants) areas (4 quadrants) of the uterus. of the uterus.

Largest area of Largest area of fluid is less than 2 fluid is less than 2 cm without loops of cm without loops of cord. cord.


Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile the Biophysical Profile

ResultResult InterpretationInterpretation RiskRiskof of

AsphyxiaAsphyxia

Risk of Risk of FetalFetalDeathDeath

RecommendRecommended ed

TreatmentTreatment

10/1010/10 Non Non asphyxiatedasphyxiated

000.5650.565ConservativConservativee

8/108/10 ((normal normal

AFVAFV ) )

Non Non asphyxiatedasphyxiated


8/88/8( ( NST NST not not

performedperformed ) )

Non Non asphyxiatedasphyxiated


8/108/10 ((decreased decreased

AFVAFV ) )

Chronic Chronic compensatedcompensated

asphyxiaasphyxia

5-105-10 ((estimateestimate ) )

20-3020-30If matureIf mature ((>>37 37 wk), wk),

deliverdeliverIf immature, If immature,

serial serial testing testing (twice (twice

weeklyweekly))

Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile Score the Biophysical Profile Score

ResultResultInterpretatiInterpretationon

RiskRiskof of

AsphyxiaAsphyxia


Recommended Recommended TreatmentTreatment

6/106/10

normalnormal

AFVAFV

Acute Acute asphyxiaasphyxiapossiblepossible

005050If mature (If mature (>>37 wk), 37 wk), deliverdeliver

If immature, repeat If immature, repeat test in 24 h test in 24 h

and if and if <<6/10, deliver6/10, deliver

6/106/10

decreasedecreased AFVd AFV

Chronic Chronic asphyxia asphyxia

withwithpossible possible

acuteacute

>10 >10 >>5050 Factor in Factor in gestational agegestational age

IfIf >>32 32 wk, deliverwk, deliverIf <32 wk, test dailyIf <32 wk, test daily

1010//44 ((normal normal

AFVAFV ) )

Acute Acute asphyxia asphyxia

likelylikely

3636115115Factor in Factor in gestational agegestational ageIfIf >>32 32 weeks, weeks,

deliverdeliverIfIf <<32 32 wk, test dailywk, test daily

Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile Score the Biophysical Profile Score

ResultResultInterpretatiInterpretationon

RiskRiskof Asphyxiaof Asphyxia


RecommendRecommended ed

TreatmentTreatment

44/10/10

decreased decreased AFVAFV

Chronic Chronic asphyxia asphyxia

withwithacute acute

asphyxiaasphyxialikelylikely

>>3636 >>115115 IfIf >>26 26 wk, wk, deliverdeliver

2/102/10

normal AFVnormal AFV

Acute Acute asphyxia asphyxia almostalmostcertaincertain

7373 220220 IfIf >>26 26 wk, wk, deliverdeliver

00/10/10Gross Gross severe severe

asphyxiaasphyxia

100100 100100 IfIf >>26 26 wk, wk, deliverdeliver

Fetal Central Nervous System CenterFetal Central Nervous System Center

Test Center WeakTest Center Weak

Fetal Tone Cortex (Fetal Tone Cortex (subcortical areasubcortical area) 8 ) 8 thth

<<7.17.1 Movement Cortex nuclei 9 Movement Cortex nuclei 9 thth

Breathing Ventral surface of 21 Breathing Ventral surface of 21 thth

the fourth ventriclethe fourth ventricle

<<7.27.2 NST Posterior hypotNST Posterior hypothalamushalamus, 2-3, 2-3

Medulla (Medulla (trimester)trimester)

Using This Score, The following Outcomes Using This Score, The following Outcomes have been reported:have been reported:

• Weighted Score 10 - Adverse Fetal Outcome 0%





Factors Affecting the Biophysical ProfileFactors Affecting the Biophysical Profile

ActivityActivityFHRFHR AcceleratioAcceleratio

nn

ToneTone GrossGrossMovemenMovemen

tt

FetalFetalBreathinBreathin

gg

AFVAFV

Fetal sleepFetal sleep

Early gestational Early gestational age (<33 wkage (<33 wk))

Late gestational Late gestational age (>42 wkage (>42 wk))

Maternal glucose Maternal glucose ingestioningestion

---- ---- ---- ----

Factors Affecting the Biophysical ProfileFactors Affecting the Biophysical ProfileActivityActivityFHRFHR

AcceleratioAccelerationn

ToneTone GrossGrossMovemenMovementt

FetalFetalBreathinBreathingg

AFVAFV

Maternal Maternal alcohol alcohol ingestioningestion

---/ ---/

---/ ---/

Maternal Maternal magnesium magnesium administrationadministration

Artifical Artifical rupture of rupture of membranesmembranes

Premature Premature rupture of rupture of membranesmembranes

LaborLabor

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“BIOPHYSICAL PROFILE”

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