The Fetal Biophysical Profile

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IN THE NAME OF GOD
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BioPhysical ProfileB.P.P

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• In 1980 Manning and colleagues introduced BPP
  for evaluation of the fetus.
• BPP is a noninvasive test that predicts the
  presence or absence of fetal asphyxia
• BBP combines data from two sources
  -FHR
  monitoring
  
  -Ultrasound

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B.P.P

• Fetal Heart Reactivity (NST)
• Fetal Breathing Movement
• Fetal Movement
• Fetal Tone
• Amniotic Fluid Volume

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Pathophysiology

• Tissue hypoxia ?stimulates the aortic carotid
  chemoreceptors (extremely high metabolism)
  ?cardiac output redistribution away from fetal
  kidneys viscera limbs in favor of the brain,
  heart , placenta and adrenal glands
  (redistribution)

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Cont.

• Chronic hypoxia ?olygohyramnios
  
  1-decreased renal perfusion ADH
  2- fetal
  lung resorption
  
  3-fetal swallowing
  
  4-decreased fluid in amniotic space
  ?pressure umbilical cord ?decreased perfusion
  
• progression of hypoxia/ acidemia? cerebral edema
  and heart failure ?poor perinatal prognosis ?high
  mortality morbidity

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Fetal Central Nervous System Centers
Hypoxia
Emberyogenesis
Hypoxia ?cellular function change (special
neuronal tissue)
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CONT.

• The centers regulating fetal movement have a
  higher threshold than those for fetal breathing
  or FHR accelerations the fetal tone center has
  the highest threshold.
• Heart rate reactivity would be the first
  parameter to be alerted, and fetal tone the
  last.
• When the NST is reactive , the presence of fetal
  acidemia is R/O.

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• The BPP highly correlates with the ante partum
  fetal umbilical venous cord PH level.
• Heart rate reactivity fetal breathing are
  inhibited at PH lt7.20
• Fetal body movements fetal
  
  tones disappear at PH
  lt7.10

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• There are 2 scoring systems
• -The original BPP described by Manning et al.
  10/10
• -Vintzileos et al in 1983 proposed another
  scoring system ,which gave intermediate scores
  (0,1,2), and also included
  placental grading as one of the biophysical
  variables.12/12

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• More than 90 of tests that are normal are
  completed within the first 4,and average testing
  time is less than 8.
• Some have suggested using fetal acoustic
  stimulation to shorten the period for testing.

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Fetal breathing

• Fetal breathing movements should be considered
  present only if they are continuous for at least
  20-30, with breath-to-breath intervals of less
  than 6.
• hiccups also count as breathing movements
• Scoring
• -gt1 episode of breathinggt30in 302 points
• -No episode of breathinggt30 in 300 points

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CONT.

• Fetal breathing movements fetal activities are
  reduced during maternal fasting
• The unusual presence of CONTINUOUS MONOTONOUS
  fetal breathing, with complete absence of all
  other behavior for an extended period , may
  indicate acidosis, especially in diabetic fetus

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Body Movement

• Gross motor activities
  
  -body/ trunk roll
  
  -spine flexion or
  extension
  -gross
  limb movement
• Fine-motor activities
  
  -eye movement
  
  -sucking
  /swallowing
• Scoring
  
  -gt3 movements in 302
  points
  -lt3 movements
  in 300 points

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Fetal tone

• Active limb movement
  -Flexion? extension? flexion
  
  -Hand opens and closes
• Scoring
  -gt1 episodes in 302
  points
  - 0 episodes in 300 points

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Amniotic fluid (AF) volume

• Largest AF pocket is found in vertical
  transverse measurement
• Different than 4 quadrant Amniotic Fluid
  Index/AFI
• Use color Doppler for AF assessment
  - help avoid measurement of
  cord in AF pockets
• Careful attention to transducer pressure is
  required to avoid a false diagnosis of
  oligohydramnios
• Scoring
  -gt1
  pocket of fluid gt 2cm 2cm2 points
  -No
  pocket of fluid gt 2cm 2cmo points

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CONT.

• The BPP is a combination of acute chronic
  markers reflecting fetal well-being
• acute
  
  -fetal heart rate reactivity
  -fetal
  breathing movements
  -fetal
  movements
  
  -fetal tone
• chronic
  
  amniotic fluid volume
• 3 wks for significant oligohydramnios to
  develop

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Cont.

• The only score that is allowed to stand after
  the US variables have been evaluated is 8/8.
• A score of 6/8 is not a BPS.
• When the 4 US variables are performed first
  (modification), if any of these is absent, NST
  (only 10) must be performed before the BPS is
  complete, and the score will be x/10.
• Modification reduced the need for NST in 95
  percent of cases and the average testing time
  per patient without reducing the predictive value
  of the test.

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Modified B.P.P

• The modified biophysical profile was developed to
  simplify the examination and reduce the time
  necessary to complete testing .
• It is consisting of an NST AFI
• The rate of stillbirth within one week of a
  normal test is the same as with the full BPS, 0.8
  per 1000 women tested.
• The AFI is derived by adding the largest
  vertically measured pocket from each uterine
  quadrant.
• Oligohydramnios is defined as an AFI of less than
  6/ 5cm.
• If either NST or the AFI is abnormal, a complete
  BPP or a OCT is performed

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Cont.

• A normal BPP (of gt8) is considered predictive of
  a nonacidotic fetus.
• The presence of oligohydromnios in either
  scoring system is considered abnormal, because
  reduced AF puts the fetus at risk of cord
  compression , death, or adverse perinatal
  outcomes, regardless the scores of the other
  biophysical parameters.

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