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

3. 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.

4. parameters
Non-Stress Test Ultrasound

5. 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 /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

6. 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

7. 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

8. 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.

9. Biophysical Profile Variables
Fetal breathing movements
Gross body movement
Fetal tone
Amniotic fluid volume index
Non-stress test

10. 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

11. 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

12. 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.

14. 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

15. 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

16. 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

17. 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

24. 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)

25. 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)

26. 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

31. Fetal Central Nervous System Center
Test Center Weak
Fetal Tone Cortex (subcortical area) th
< Movement Cortex nuclei th
Breathing Ventral surface of th
the fourth ventricle
< NST Posterior hypothalamus,
Medulla (trimester)
Embriogenesis
Hypoxia

33. 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%

38. 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

39. 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

40. THANK YOU