“BIOPHYSICAL PROFILE” Dr Seyed Asadollah Kalantari OB & Gynecologist Isfahan Fertility & Infertility Center

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. The fetal response to hypoxia is: Alteration in movement, muscle tone, breathing and heart rate patterns. BPP is an accurate indicator of impending fetal death. Fetal acidosis can be diagnosed early with a nonreactive nonstress test and absent fetal breathing movements. An abnormal BPP score and oligohydramnios are indications that labor should be induced. Fetal infection in women who have ROM prior to 37 weeks, can be diagnosed early by changes in biophysical activity that precede the clinical signss of infection and indicate the necessity for immediate birth.

parameters Non-Stress Test Ultrasound

Biophysical 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? 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 Indications 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 APLS Hyperthyroidism Hemoglobinopathies Cyanotic heart disease SLE Chronic renal disease DM 1 and 2

PATHOPHYSIOLOGIC BASIS OF THE 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 Variables Fetal breathing movements Gross body movement Fetal tone Amniotic fluid volume index Non-stress test

Basic Physiology & PathoPhysiology of 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 Regulatory Centers Gestational Age of Maturation (wk) Activity 6 Gross body movements 1412- Breathing movements 18-20 FHR accelerations resulting from fetal movement 18-22 Sleep-wake cycles 28 Integrated behavioral patterns

Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal (0 points) Normal (2 points) Measurement Breathing movement is less than 20 seconds or no breathing is observed. 1 or more breathing movements last at least 20 seconds. Breathing movement.

Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal Abnormal (0 points) Normal (2 points) Measurement Less than 3 movements are observed. 3 movements of the arms, legs, or body are observed. Body movements

Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal Abnormal (0 points) Normal (2 points) Measurement Arms and legs are flexed with head on chest. No extension and flexion is observed. and legs are usually flexed and the head rests on the chest. 1 or more extensions and return to flexion are observed. Muscle tone

Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal (0 points) Normal (2 points) Measurement Only 1 heart rate increase is observed or heart rate does not increase with movement. test2 or more heart rate increases of 15 beats per minute or more are observed with movement. Non stress test

Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal Abnormal (0 points) Normal (2 points) Measurement Largest area of fluid is less than 2 cm without loops of cord. Largest area of fluid is greater than 2 cm without containing loops of the umbilical cord. Or the amniotic fluid index (AFI) shows a total of more than 5 cm of fluid in 4 areas (4 quadrants) of the uterus. Amniotic fluid volume

Recommended Fetal Treatment According to the Biophysical Profile Recommended Treatment Risk of Fetal Death Risk of Asphyxia Interpretation Result Conservative 0.565 Non asphyxiated 10/10 8/10 (normal AFV) 8/8 (NST not performed) If mature (>37 wk), deliver If immature, serial testing (twice weekly) 20-30 5-10 (estimate) Chronic compensated asphyxia 8/10 (decreased AFV)

Recommended Fetal Treatment According to the Biophysical Profile Score Recommended Treatment Risk of Fetal Death Risk of Asphyxia Interpretation Result If mature (>37 wk), deliver If immature, repeat test in 24 h and if <6/10, deliver 50 Acute asphyxia possible 6/10 normal AFV Factor in gestational age If >32 wk, deliver If <32 wk, test daily >50 >10 Chronic asphyxia with possible acute decreased AFV Factor in gestational age If >32 weeks, deliver If <32 wk, test daily 115 36 Acute asphyxia likely 10/4 (normal AFV)

Recommended Fetal Treatment According to the Biophysical Profile Score Recommended Treatment Risk of Fetal Death Risk of Asphyxia Interpretation Result If >26 wk, deliver >115 >36 Chronic asphyxia with acute asphyxia likely 4/10 decreased AFV 220 73 Acute asphyxia almost certain 2/10 normal AFV 100 Gross severe asphyxia 0/10

Fetal Central Nervous System Center Test Center Weak Fetal Tone Cortex (subcortical area) 8 th <7.1 Movement Cortex nuclei 9 th Breathing Ventral surface of 21 th the fourth ventricle <7.2 NST Posterior hypothalamus, 2-3 Medulla (trimester) Embriogenesis Hypoxia

Using This Score, The following Outcomes have been reported: Weighted Score 10 - Adverse Fetal Outcome 0% Weighted Score 8 - Adverse Fetal Outcome 0% Weighted Score 6 - Adverse Fetal Outcome 1% Weighted Score 4 - Adverse Fetal Outcome 22% Weighted Score 2 - Adverse Fetal Outcome 77%

Factors Affecting the Biophysical Profile AFV Fetal Breathing Gross Movement Tone FHR Acceleration Activity Fetal sleep Early gestational age (<33 wk) Late gestational age (>42 wk) ---- Maternal glucose ingestion

Factors Affecting the Biophysical Profile AFV Fetal Breathing Gross Movement Tone FHR Acceleration Activity /--- Maternal alcohol ingestion Maternal magnesium administration Artifical rupture of membranes Premature rupture of membranes Labor

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