The fetal biophysical profile
- Frank A Manning, MD
Frank A Manning, MD
- Clinical Professor of Obstetrics and Gynecology
- Albert Einstein College of Medicine
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
The fetal biophysical profile (BPP) is a noninvasive, easily learned and performed procedure for evaluating the fetus for signs of compromise. Ultrasound is used to assess four discrete biophysical parameters: fetal movement, fetal tone, fetal breathing, and amniotic fluid volume. A separate nonstress test of the fetal heart rate can also be performed. Each of the four ultrasound parameters and the nonstress test are given a score of 0 or 2 points (no 1 point), depending upon whether specific criteria are met (table 1). A total score ≥8 implies absence of significant central nervous system hypoxemia/acidemia at the time of testing. A score ≤4 can be a sign of fetal compromise. Ideally, identification of a compromised fetus will enable the provider to perform interventions that prevent adverse fetal sequelae.
This topic will review issues related to the BPP. An overview of antenatal fetal surveillance and information on the nonstress test and the contraction stress test are available separately. (See "Overview of antepartum fetal surveillance" and "Nonstress test and contraction stress test".)
The American College of Obstetricians and Gynecologists recommends antepartum fetal surveillance with tests such as the BPP for pregnancies at increased risk of antepartum fetal demise . Specific indications for antenatal fetal assessment are discussed separately. (See "Overview of antepartum fetal surveillance", section on 'Indications for fetal surveillance'.)
Although the BPP is typically used for antepartum fetal assessment, it can also be performed intrapartum; however, its clinical utility in the intrapartum setting is unclear [2,3].
PHYSIOLOGIC BASIS OF BIOPHYSICAL MONITORING
All biophysical activities are regulated and controlled by discrete centers in the brain that are sensitive to both local factors and feedback from peripheral sensors. The presence of normal biophysical activity is presumptive evidence that these regulatory centers are intact, while the loss of normal biophysical activity can be a sign of pathologic neuronal suppression from hypoxemia, acidemia, and ischemia. However, the absence or diminution of a given biophysical activity is not always pathologic. Normal suppression of a regulatory center can occur from intrinsic fetal rhythms, such as the deep stage of quiet sleep, or from transplacental passage of drugs that cause general suppression of the brain, such as sedatives and opiates.
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- PHYSIOLOGIC BASIS OF BIOPHYSICAL MONITORING
- Fetal movement, tone, breathing, and heart rate acceleration
- Amniotic fluid volume
- DETERMINING THE BIOPHYSICAL PROFILE SCORE
- Can the nonstress test be omitted?
- Modified biophysical profile
- Factors potentially affecting test results
- EVIDENCE OF EFFICACY
- INITIATION AND FREQUENCY OF TESTING
- ROUTE OF DELIVERY AFTER A LOW BPP SCORE
- SUMMARY AND RECOMMENDATIONS