Biophysical profile

Biophysical profile
Synonyms	BPP
Purpose	prenatal evaluation ultrasound

A biophysical profile (BPP) is a prenatal ultrasound evaluation of fetal well-being involving a scoring system,^[1] with the score being termed Manning's score.^[2] It is often done when a non-stress test (NST) is non reactive, or for other obstetrical indications.

The "modified biophysical profile" consists of the NST and amniotic fluid index only.

Procedure

The BPP has five components: four ultrasound (US) assessments and an NST. The NST evaluates fetal heart rate and response to fetal movement. The five discrete biophysical variables are:

1. Fetal heart rate
2. Fetal breathing
3. Fetal movement
4. Fetal tone
5. Amniotic fluid volume

Parameter	Normal (2 points)	Abnormal (0 points)
NST/Reactive FHR	At least two accelerations in 20 minutes	Less than two accelerations to satisfy the test in 20 minutes
US: Fetal breathing movements	At least one episode of > 30s or >20s[3] in 30 minutes	None or less than 30s or 20s[3]
US: Fetal activity / gross body movements	At least three discrete body/limb movement in 30 minutes (episodes of active continuous movement considered a single movement.	Less than three or two[3] movements
US: Fetal muscle tone	At least one[3] episode of active extension with return to flexion of fetal limb(s) or trunk, opening and closing of hand considered to be normal tone.	Either slow extension with return to partial flexion or movement of limb in full extension or absent fetal movement.
US: Qualitative AFV/AFI	At least one vertical pocket > 2 cm in the vertical axis or AFI of 5 cm	Largest vertical pocket </= 2 cm, or AFI </= 5 cm

Use of vibroacoustic stimulation to accelerate evaluation has been described.^[4]

Interpretation

Each assessment is graded either 0 or 2 points and then added up to yield a number between 0 and 10. A BPP of 8 or 10 is generally considered reassuring. A BPP normally is not performed before the second half of a pregnancy since fetal movements do not occur in the first half.^[5] The presence of these biophysical variables implies absence of significant central nervous system hypoxemia/acidemia at the time of testing. By comparison, a compromised fetus typically exhibits loss of accelerations of the fetal heart rate (FHR), decreased body movement and breathing, hypotonia, and, less acutely, decreased amniotic fluid volume.

Recommended management based on the biophysical profile^[6]

BPP	Recommended management
≤2	Labor induction
4	Labor induction if gestational age >32 weeks Repeating test same day if <32 weeks, then delivery if BPP <6
6	Labor induction if >36 weeks if favorable cervix and normal AFI Repeating test in 24 hours if <36 weeks and cervix unfavorable; then delivery if BPP <6, and follow-up if >6
≥ 8	Labor induction if presence of oligohydramnios

See also

• Nonstress test
• Cardiotocography

References

1. Lalor JG, Fawole B, Alfirevic Z, Devane D (2008-01-23). "Biophysical profile for fetal assessment in high risk pregnancies". The Cochrane Database of Systematic Reviews. 2008 (1): CD000038. doi:10.1002/14651858.CD000038.pub2. ISSN 1469-493X. PMC 7052779. PMID 18253968.
2. Page 215, Chapter 39 on Biophysical Profile (BPP), in: Title: Diagnostic Ultrasound, Volume: 2, Issue: 1 of The Veterinary clinics of North America. Equine practice, Author: Norman W. Rantanen. Publisher: Jaypee Brothers Publishers, 1986. ISBN 9788184480641. Length: 261 pages
3. "Biophysical Profile, Ultrasound: eMedicine Radiology". Retrieved 2009-12-29.
4. Pinette MG, Blackstone J, Wax JR, Cartin A (June 2005). "Using fetal acoustic stimulation to shorten the biophysical profile". J Clin Ultrasound. 33 (5): 223–5. doi:10.1002/jcu.20116. PMID 16047387. S2CID 32503466.
5. Mari E (2018-04-17). "Decreased Fetal Movements are an Important Red Flag in Second Half of Pregnancy: A Case Report of Baby Saved by Mother's Attention to Fetal Movements". Current Opinion in Gynecology and Obstetrics. 1 (1): 21–27. doi:10.18314/cogo.v1i1.862. ISSN 2637-4617. S2CID 59490398.
6. Intrauterine Growth Retardation. ROBERT C. VANDENBOSCHE, M.D., and JEFFREY T. KIRCHNER, D.O., Lancaster General Hospital, Lancaster, Pennsylvania. Am Fam Physician. 1998 Oct 15;58(6):1384-1390. [1] "Archived copy" (PDF). Archived from the original (PDF) on 2013-05-13. Retrieved 2012-08-02.