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The fetal biophysical profile

Frank A Manning, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


The fetal biophysical profile score (BPS or BPP) refers to the sonographic assessment of four discrete biophysical variables:

Fetal movement

Fetal tone

Fetal breathing

Amniotic fluid volume


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Literature review current through: Sep 2015. | This topic last updated: May 11, 2015.
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  1. Morrison I. Perinatal mortality: basic considerations. Semin Perinatol 1985; 9:144.
  2. Chamberlain P. Late fetal death--has ultrasound a role to play in its prevention? Ir J Med Sci 1991; 160:251.
  3. Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 113:687.
  4. Rurak DW, Gruber NC. The effect of neuromuscular blockade on oxygen consumption and blood gases in the fetal lamb. Am J Obstet Gynecol 1983; 145:258.
  5. Harman CR, Menticoglou S, Manning FA. Fetal oxygen uptake: A test of placental reserve. Proc Soc Obstet Gynecol Canada 1993.
  6. Moore TR. Superiority of the four-quadrant sum over the single-deepest-pocket technique in ultrasonographic identification of abnormal amniotic fluid volumes. Am J Obstet Gynecol 1990; 163:762.
  7. Manning FA, Morrison I, Lange IR, et al. Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high-risk pregnancies. I. Perinatal mortality by frequency and etiology. Am J Obstet Gynecol 1985; 151:343.
  8. Manning FA. Fetal biophysical profile. Obstet Gynecol Clin North Am 1999; 26:557.
  9. Vintzileos AM, Fleming AD, Scorza WE, et al. Relationship between fetal biophysical activities and umbilical cord blood gas values. Am J Obstet Gynecol 1991; 165:707.
  10. Manning FA, Bondaji N, Harman CR, et al. Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates. Am J Obstet Gynecol 1998; 178:696.
  11. Manning FA, Snijders R, Harman CR, et al. Fetal biophysical profile score. VI. Correlation with antepartum umbilical venous fetal pH. Am J Obstet Gynecol 1993; 169:755.
  12. Ribbert LS, Snijders RJ, Nicolaides KH, Visser GH. Relationship of fetal biophysical profile and blood gas values at cordocentesis in severely growth-retarded fetuses. Am J Obstet Gynecol 1990; 163:569.
  13. Chamberlain PF, Manning FA, Morrison I, et al. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome. Am J Obstet Gynecol 1984; 150:245.
  14. Phelan JP, Ahn MO, Smith CV, et al. Amniotic fluid index measurements during pregnancy. J Reprod Med 1987; 32:601.
  15. Cohn HE, Sacks EJ, Heymann MA, Rudolph AM. Cardiovascular responses to hypoxemia and acidemia in fetal lambs. Am J Obstet Gynecol 1974; 120:817.
  16. Nicolaides KH, Peters MT, Vyas S, et al. Relation of rate of urine production to oxygen tension in small-for-gestational-age fetuses. Am J Obstet Gynecol 1990; 162:387.
  17. Sherer DM, Dayal AK, Schwartz BM, et al. Acute oligohydramnios and deteriorating fetal biophysical profile associated with severe preeclampsia. J Matern Fetal Med 1999; 8:193.
  18. Manning FA, Platt LD, Sipos L. Antepartum fetal evaluation: development of a fetal biophysical profile. Am J Obstet Gynecol 1980; 136:787.
  19. Manning FA, Baskett TF, Morrison I, Lange I. Fetal biophysical profile scoring: a prospective study in 1,184 high-risk patients. Am J Obstet Gynecol 1981; 140:289.
  20. Pillai M, James D. Behavioural states in normal mature human fetuses. Arch Dis Child 1990; 65:39.
  21. Patrick JE, Dalton KJ, Dawes GS. Breathing patterns before death in fetal lambs. Am J Obstet Gynecol 1976; 125:73.
  22. Manning FA, Martin CB Jr, Murata Y, et al. Breathing movements before death in the primate fetus (Macaca mulatta). Am J Obstet Gynecol 1979; 135:71.
  23. Romero R, Chervenak FA, Berkowitz RL, Hobbins JC. Intrauterine fetal tachypnea. Am J Obstet Gynecol 1982; 144:356.
  24. Nageotte MP, Towers CV, Asrat T, Freeman RK. Perinatal outcome with the modified biophysical profile. Am J Obstet Gynecol 1994; 170:1672.
  25. Miller DA, Rabello YA, Paul RH. The modified biophysical profile: antepartum testing in the 1990s. Am J Obstet Gynecol 1996; 174:812.
  26. Subtil D, Tiberghien P, Devos P, et al. Immediate and delayed effects of antenatal corticosteroids on fetal heart rate: a randomized trial that compares betamethasone acetate and phosphate, betamethasone phosphate, and dexamethasone. Am J Obstet Gynecol 2003; 188:524.
  27. Mulder EJ, Derks JB, Visser GH. Antenatal corticosteroid therapy and fetal behaviour: a randomised study of the effects of betamethasone and dexamethasone. Br J Obstet Gynaecol 1997; 104:1239.
  28. Senat MV, Minoui S, Multon O, et al. Effect of dexamethasone and betamethasone on fetal heart rate variability in preterm labour: a randomised study. Br J Obstet Gynaecol 1998; 105:749.
  29. Rotmensch S, Liberati M, Vishne TH, et al. The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial. Acta Obstet Gynecol Scand 1999; 78:493.
  30. Kelly MK, Schneider EP, Petrikovsky BM, Lesser ML. Effect of antenatal steroid administration on the fetal biophysical profile. J Clin Ultrasound 2000; 28:224.
  31. Rotmensch S, Liberati M, Celentano C, et al. The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand 1999; 78:768.
  32. Katz M, Meizner I, Holcberg G, et al. Reduction or cessation of fetal movements after administration of steroids for enhancement of lung maturation. I. Clinical evaluation. Isr J Med Sci 1988; 24:5.
  33. Wijnberger LD, Bilardo CM, Hecher K, et al. Effect of antenatal glucocorticoid therapy on arterial and venous blood flow velocity waveforms in severely growth-restricted fetuses. Ultrasound Obstet Gynecol 2004; 23:584.
  34. Karaer C, Onderoglu L, Yigit N, et al. The effect of steroids on the biophysical profile and Doppler indices of umbilical and middle cerebral arteries in healthy preterm fetuses. Eur J Obstet Gynecol Reprod Biol 2001; 99:72.
  35. Derks JB, Giussani DA, Jenkins SL, et al. A comparative study of cardiovascular, endocrine and behavioural effects of betamethasone and dexamethasone administration to fetal sheep. J Physiol 1997; 499 ( Pt 1):217.
  36. Koenen SV, Mecenas CA, Smith GS, et al. Effects of maternal betamethasone administration on fetal and maternal blood pressure and heart rate in the baboon at 0.7 of gestation. Am J Obstet Gynecol 2002; 186:812.
  37. Smith RP, Miller SL, Igosheva N, et al. Cardiovascular and endocrine responses to cutaneous electrical stimulation after fentanyl in the ovine fetus. Am J Obstet Gynecol 2004; 190:836.
  38. Vintzileos AM. Antepartum surveillance in preterm rupture of membranes. J Perinat Med 1996; 24:319.
  39. Lewis DF, Adair CD, Weeks JW, et al. A randomized clinical trial of daily nonstress testing versus biophysical profile in the management of preterm premature rupture of membranes. Am J Obstet Gynecol 1999; 181:1495.
  40. Ghidini A, Salafia CM, Kirn V, et al. Biophysical profile in predicting acute ascending infection in preterm rupture of membranes before 32 weeks. Obstet Gynecol 2000; 96:201.
  41. Del Valle GO, Joffe GM, Izquierdo LA, et al. The biophysical profile and the nonstress test: poor predictors of chorioamnionitis and fetal infection in prolonged preterm premature rupture of membranes. Obstet Gynecol 1992; 80:106.
  42. Gauthier DW, Meyer WJ, Bieniarz A. Biophysical profile as a predictor of amniotic fluid culture results. Obstet Gynecol 1992; 80:102.
  43. Honest H, Bachmann LM, Sengupta R, et al. Accuracy of absence of fetal breathing movements in predicting preterm birth: a systematic review. Ultrasound Obstet Gynecol 2004; 24:94.
  44. Tug N, Ayvaci H, Tarhan N, et al. Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores. Arch Gynecol Obstet 2011; 283:461.
  45. Walach N. [Cancer in husband and wife--a report of 105 couples]. Harefuah 1991; 120:8.
  46. Manning FA, Morrison I, Lange IR, et al. Fetal biophysical profile scoring: selective use of the nonstress test. Am J Obstet Gynecol 1987; 156:709.
  47. Alfirevic Z, Neilson JP. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev 2000; :CD000038.
  48. Gribbin C, James D. Assessing fetal health. Best Pract Res Clin Obstet Gynaecol 2004; 18:411.
  49. Nageotte MP, Towers CV, Asrat T, et al. The value of a negative antepartum test: contraction stress test and modified biophysical profile. Obstet Gynecol 1994; 84:231.
  50. Manning FA, Morrison I, Harman CR, et al. Fetal assessment based on fetal biophysical profile scoring: experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths. Am J Obstet Gynecol 1987; 157:880.
  51. Manning FA. Fetal biophysical profile: a critical appraisal. Clin Obstet Gynecol 2002; 45:975.
  52. Kaur S, Picconi JL, Chadha R, et al. Biophysical profile in the treatment of intrauterine growth-restricted fetuses who weigh <1000 g. Am J Obstet Gynecol 2008; 199:264.e1.
  53. American College of Obstetricians and Gynecologists. Antepartum fetal surveillance. ACOG practice bulletin #9, American College of Obstetricians and Gynecologists; Washington, DC 1999.
  54. Jansen AH, Chernick V. Fetal breathing and development of control of breathing. J Appl Physiol (1985) 1991; 70:1431.
  55. Kurjak A, Andonotopo W, Hafner T, et al. Normal standards for fetal neurobehavioral developments--longitudinal quantification by four-dimensional sonography. J Perinat Med 2006; 34:56.
  56. Manning FA. Dynamic ultrasound-based fetal assessment: the fetal biophysical profile score. Clin Obstet Gynecol 1995; 38:26.
  57. Kim SY, Khandelwal M, Gaughan JP, et al. Is the intrapartum biophysical profile useful? Obstet Gynecol 2003; 102:471.
  58. Sassoon DA, Castro LC, Davis JL, et al. The biophysical profile in labor. Obstet Gynecol 1990; 76:360.