### Date : 2024-12-15 13:12 ### Topic : Biophysical Profile (BPP) #OBGY ---- ### **Biophysical Profile (BPP)** The **Biophysical Profile (BPP)** is a comprehensive prenatal test that combines **ultrasound** and **fetal monitoring** to assess the **well-being** of the fetus. It evaluates the **fetal heart rate**, **breathing movements**, **body movements**, **muscle tone**, and the **amniotic fluid volume**. The BPP is typically performed in high-risk pregnancies to monitor fetal health, particularly when there are concerns about fetal growth, oxygenation, or other complications. ### **Components of the Biophysical Profile** The BPP consists of **five parameters**, each of which is scored on a scale from **0 to 2**. A total score of **10** is considered normal, and a score of **8** may still be considered normal if the amniotic fluid is adequate. Lower scores may indicate fetal distress or other issues requiring further evaluation or intervention. 1. **Fetal Heart Rate (Non-Stress Test - NST)**: - This is assessed by monitoring the **fetal heart rate (FHR)** in response to **fetal movements**. - **Criteria for scoring**: - **2 points**: **2 accelerations** in the fetal heart rate of at least **15 beats per minute** (bpm) above the baseline for at least **15 seconds** during a **20-minute period**. - **0 points**: **Absence of accelerations** or **non-reactive NST**. - **Significance**: This part evaluates the **fetal autonomic nervous system** and indicates how well the fetus is coping with the intrauterine environment. A **non-reactive NST** (absence of accelerations) may indicate fetal distress. 2. **Fetal Breathing Movements**: - **Fetal breathing** is assessed using **ultrasound**, where the fetal **diaphragm movement** is observed. - **Criteria for scoring**: - **2 points**: At least **1 episode** of **fetal breathing movements** lasting at least **30 seconds** within a **30-minute observation** period. - **0 points**: No fetal breathing movements or abnormal breathing patterns. - **Significance**: Adequate fetal breathing movements are a sign that the fetus is receiving enough oxygen and is functioning well neurologically. 3. **Fetal Body Movements**: - **Fetal movements** are also assessed by ultrasound, noting **general body movements** (limb movements, jerking motions, etc.). - **Criteria for scoring**: - **2 points**: At least **3 body movements** within **30 minutes**. - **0 points**: Fewer than 3 movements or absent movement. - **Significance**: Normal body movements are indicative of a healthy fetus with adequate oxygenation and neurological development. Decreased fetal movements can be a sign of **fetal distress** or **hypoxia**. 4. **Fetal Muscle Tone**: - This is assessed by ultrasound, where the fetus' **muscle tone** is observed. **Tone** is measured by checking for **flexion and extension** of the arms, legs, or hands. - **Criteria for scoring**: - **2 points**: At least **1 episode** of **active extension** and **flexion** of the extremities (e.g., the fetus bends its arms and legs). - **0 points**: No muscle tone or abnormal tone (e.g., the fetus appears limp with no movement). - **Significance**: Fetal muscle tone reflects the **neurological development** and **muscle function**. Poor muscle tone can be a sign of **fetal distress** or **neurological issues**. 5. **Amniotic Fluid Volume (AFV)**: - This is assessed by measuring the **amount of amniotic fluid** around the fetus using **ultrasound**. The **amniotic fluid index (AFI)** is calculated, or a **single pocket measurement** may be used. - **Criteria for scoring**: - **2 points**: Normal or **adequate amniotic fluid volume**, which is usually indicated by an **AFI of 5-25 cm** or a **single fluid pocket** that measures at least **2 cm**. - **0 points**: **Oligohydramnios** (low amniotic fluid), with an **AFI <5 cm** or a single fluid pocket measuring **<2 cm**. - **Significance**: Adequate amniotic fluid is essential for **fetal movement**, **lung development**, and **cushioning**. Low amniotic fluid (oligohydramnios) can be a sign of **placental insufficiency**, **fetal growth restriction**, or other complications. --- ### **Scoring of the Biophysical Profile (BPP)** - Each of the five parameters is assigned a score of **0 or 2**. - **2 points**: Normal findings. - **0 points**: Abnormal or absent findings. - The total score is the sum of all five components: - **8-10 points**: **Normal** fetal well-being, especially if amniotic fluid is adequate. - **6 points**: May suggest the need for further evaluation, such as **fetal monitoring** or additional tests (e.g., **fetal kick counts**, **Doppler studies**, or **NST**). - **4 or fewer points**: Indicates possible **fetal distress** and typically requires **immediate intervention**, such as **delivery** or further diagnostic tests. ### **Interpretation of the Biophysical Profile (BPP)** 1. **8-10 points**: - This is considered a **normal** result, indicating a healthy fetus with adequate oxygenation and development. 2. **6 points**: - This suggests the fetus may be at **risk**, but additional monitoring or intervention may be required. The interpretation may depend on the **gestational age**, the clinical situation, and the **mother’s health**. 3. **4 or fewer points**: - This score suggests a **fetus in distress**. Further investigation and urgent intervention, including possible **delivery** or additional tests, may be necessary to ensure fetal well-being. ### **Advantages of the Biophysical Profile (BPP)** 1. **Comprehensive Assessment**: The BPP provides a thorough evaluation of fetal health, assessing both **fetal movements** and **heart rate** as well as physical features like **breathing movements** and **muscle tone**. 2. **Non-invasive**: The test is performed using **ultrasound** and **external fetal heart rate monitoring**, making it a **safe** and **non-invasive** method for assessing fetal health. 3. **Predictive Value**: The BPP is highly predictive of fetal well-being and can help guide **clinical management**, including decisions regarding **timing of delivery** in high-risk pregnancies. ### **Disadvantages of the Biophysical Profile (BPP)** 1. **False Positives/Negatives**: The BPP is not infallible. A **non-reactive** or **low score** does not always indicate a problem, and a **high score** does not always rule out fetal complications. 2. **Limited to the Testing Window**: It reflects fetal well-being only at the time of the test. Fetal condition can change, and periodic monitoring may be necessary. 3. **Time-consuming**: The test can take **30-60 minutes** to perform, and may be difficult in certain clinical settings, particularly when the fetus is not very active. ### **Conclusion** The **Biophysical Profile (BPP)** is a valuable and comprehensive screening tool used to assess **fetal health** in high-risk pregnancies. By evaluating **fetal heart rate**, **breathing movements**, **body movements**, **muscle tone**, and **amniotic fluid volume**, the BPP provides an overall picture of fetal well-being and can help detect signs of **fetal distress** or complications like **fetal hypoxia**. A low score (especially below 6) indicates the need for further testing or immediate intervention to ensure the safety of the fetus. ### Reference: - ### Connected Documents: -