“biophysical profile” dr seyed asadollah kalantari ob & gynecologist isfahan fertility &...
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““BIOPHYSICAL PROFILE”BIOPHYSICAL PROFILE”
Dr Seyed Asadollah KalantariDr Seyed Asadollah KalantariOB & GynecologistOB & Gynecologist
Isfahan Fertility & Infertility Isfahan Fertility & Infertility CenterCenter
BIOPHYSICAL PROFILE (BPP)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.
parametersparameters Non-Stress Test
Ultrasound
Biophysical profileBiophysical 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?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 IndicationsMaternal and Fetal Indications
• APLS• Hyperthyroidism• Hemoglobinopathies• Cyanotic heart disease• SLE• Chronic renal disease• DM 1 and 2
• 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
PATHOPHYSIOLOGIC BASIS OF THEPATHOPHYSIOLOGIC BASIS OF THE BIOPHYSICAL PROFILE 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 Biophysical Profile Variables Variables
• Fetal breathing movements• Gross body movement• Fetal tone• Amniotic fluid volume index• Non-stress test
Basic Physiology & PathoPhysiology ofBasic Physiology & PathoPhysiology of BIOPHYSICAL PROFILE 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 Maturation of Central Nervous System Regulatory CentersRegulatory Centers
ActivityActivity Gestational AgeGestational Ageof Maturationof Maturation((wkwk))
Gross body movementsGross body movements66
Breathing movementsBreathing movements 14141212--
FHR accelerations resulting FHR accelerations resulting from fetal movementfrom fetal movement
18-2018-20
Sleep-wake cyclesSleep-wake cycles 18-2218-22
Integrated behavioral Integrated behavioral patternspatterns
2828
Criteria for Coding Fetal Biophysical Variables as
Normal or Abnormal MeasuremenMeasurementt
Normal Normal
(2 points)(2 points)AbnormalAbnormal
(0 points)(0 points)
Breathing Breathing movement.movement.
1 or more 1 or more breathing breathing movements movements last at least last at least 20 seconds.20 seconds.
Breathing Breathing movement is movement is less than 20 less than 20 seconds or no seconds or no breathing is breathing is observed.observed.
MeasuremenMeasurementt
Normal Normal
(2 points)(2 points)AbnormalAbnormal
(0 points)(0 points)
Body Body movementsmovements
3 movements 3 movements of the arms, of the arms, legs, or body legs, or body are observed.are observed.
Less than 3 Less than 3 movements movements are observed.are observed.
Criteria for Coding Fetal Biophysical VariablesCriteria for Coding Fetal Biophysical Variables as Normal or Abnormalas Normal or Abnormal
MeasurementMeasurementNormal Normal
(2 points)(2 points)AbnormalAbnormal
(0 points)(0 points)
Muscle toneMuscle toneand legs are and legs are usually flexed usually flexed and the head and the head rests on the rests on the chest. 1 or chest. 1 or more more extensions extensions and return to and return to flexion are flexion are observed.observed.
Arms and legs Arms and legs are flexed with are flexed with head on chest. head on chest. No extension No extension and flexion is and flexion is observed.observed.
Criteria for Coding Fetal Biophysical VariablesCriteria for Coding Fetal Biophysical Variables as Normal or Abnormalas Normal or Abnormal
Criteria for Coding Fetal Biophysical Variables Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal as Normal or Abnormal
MeasuremenMeasurementt
Normal Normal
(2 points)(2 points)AbnormalAbnormal
(0 points)(0 points)
Non stress Non stress testtest
test2 or more test2 or more heart rate heart rate increases of increases of 15 beats per 15 beats per minute or minute or more are more are observed observed with with movement. movement.
Only 1 heart Only 1 heart rate increase rate increase is observed or is observed or heart rate heart rate does not does not increase with increase with movement.movement.
MeasuremenMeasurementt
Normal Normal
(2 points)(2 points)AbnormalAbnormal
(0 points)(0 points)
Amniotic Amniotic fluid volumefluid volume
Largest area of fluid Largest area of fluid is greater than 2 cm is greater than 2 cm without containing without containing loops of the umbilical loops of the umbilical cord. Or the amniotic cord. Or the amniotic fluid index (AFI) fluid index (AFI) shows a total of more shows a total of more than 5 cm of fluid in 4 than 5 cm of fluid in 4 areas (4 quadrants) areas (4 quadrants) of the uterus. of the uterus.
Largest area of Largest area of fluid is less than 2 fluid is less than 2 cm without loops of cm without loops of cord. cord.
Criteria for Coding Fetal Biophysical VariablesCriteria for Coding Fetal Biophysical Variables as Normal or Abnormalas Normal or Abnormal
Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile the Biophysical Profile
ResultResult InterpretationInterpretation RiskRiskof of
AsphyxiaAsphyxia
Risk of Risk of FetalFetalDeathDeath
RecommendRecommended ed
TreatmentTreatment
10/1010/10 Non Non asphyxiatedasphyxiated
000.5650.565ConservativConservativee
8/108/10 ((normal normal
AFVAFV ) )
Non Non asphyxiatedasphyxiated
000.5650.565ConservativConservativee
8/88/8( ( NST NST not not
performedperformed ) )
Non Non asphyxiatedasphyxiated
000.5650.565ConservativConservativee
8/108/10 ((decreased decreased
AFVAFV ) )
Chronic Chronic compensatedcompensated
asphyxiaasphyxia
5-105-10 ((estimateestimate ) )
20-3020-30If matureIf mature ((>>37 37 wk), wk),
deliverdeliverIf immature, If immature,
serial serial testing testing (twice (twice
weeklyweekly))
Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile Score the Biophysical Profile Score
ResultResultInterpretatiInterpretationon
RiskRiskof of
AsphyxiaAsphyxia
Risk of Risk of FetalFetalDeathDeath
Recommended Recommended TreatmentTreatment
6/106/10
normalnormal
AFVAFV
Acute Acute asphyxiaasphyxiapossiblepossible
005050If mature (If mature (>>37 wk), 37 wk), deliverdeliver
If immature, repeat If immature, repeat test in 24 h test in 24 h
and if and if <<6/10, deliver6/10, deliver
6/106/10
decreasedecreased AFVd AFV
Chronic Chronic asphyxia asphyxia
withwithpossible possible
acuteacute
>10 >10 >>5050 Factor in Factor in gestational agegestational age
IfIf >>32 32 wk, deliverwk, deliverIf <32 wk, test dailyIf <32 wk, test daily
1010//44 ((normal normal
AFVAFV ) )
Acute Acute asphyxia asphyxia
likelylikely
3636115115Factor in Factor in gestational agegestational ageIfIf >>32 32 weeks, weeks,
deliverdeliverIfIf <<32 32 wk, test dailywk, test daily
Recommended Fetal Treatment According toRecommended Fetal Treatment According to the Biophysical Profile Score the Biophysical Profile Score
ResultResultInterpretatiInterpretationon
RiskRiskof Asphyxiaof Asphyxia
Risk of Risk of FetalFetalDeathDeath
RecommendRecommended ed
TreatmentTreatment
44/10/10
decreased decreased AFVAFV
Chronic Chronic asphyxia asphyxia
withwithacute acute
asphyxiaasphyxialikelylikely
>>3636 >>115115 IfIf >>26 26 wk, wk, deliverdeliver
2/102/10
normal AFVnormal AFV
Acute Acute asphyxia asphyxia almostalmostcertaincertain
7373 220220 IfIf >>26 26 wk, wk, deliverdeliver
00/10/10Gross Gross severe severe
asphyxiaasphyxia
100100 100100 IfIf >>26 26 wk, wk, deliverdeliver
Fetal Central Nervous System CenterFetal Central Nervous System Center
Test Center WeakTest Center Weak
Fetal Tone Cortex (Fetal Tone Cortex (subcortical areasubcortical area) 8 ) 8 thth
<<7.17.1 Movement Cortex nuclei 9 Movement Cortex nuclei 9 thth
Breathing Ventral surface of 21 Breathing Ventral surface of 21 thth
the fourth ventriclethe fourth ventricle
<<7.27.2 NST Posterior hypotNST Posterior hypothalamushalamus, 2-3, 2-3
Medulla (Medulla (trimester)trimester)
Using This Score, The following Outcomes Using This Score, The following Outcomes have been reported: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 ProfileFactors Affecting the Biophysical Profile
ActivityActivityFHRFHR AcceleratioAcceleratio
nn
ToneTone GrossGrossMovemenMovemen
tt
FetalFetalBreathinBreathin
gg
AFVAFV
Fetal sleepFetal sleep
Early gestational Early gestational age (<33 wkage (<33 wk))
Late gestational Late gestational age (>42 wkage (>42 wk))
Maternal glucose Maternal glucose ingestioningestion
---- ---- ---- ----
Factors Affecting the Biophysical ProfileFactors Affecting the Biophysical ProfileActivityActivityFHRFHR
AcceleratioAccelerationn
ToneTone GrossGrossMovemenMovementt
FetalFetalBreathinBreathingg
AFVAFV
Maternal Maternal alcohol alcohol ingestioningestion
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Maternal Maternal magnesium magnesium administrationadministration
Artifical Artifical rupture of rupture of membranesmembranes
Premature Premature rupture of rupture of membranesmembranes
LaborLabor
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