BIOPHYSICAL PROFILE

Principle
• It is a screening test for uteroplacental insufficiency.
• Fetal biophysical activities are initiated, modulated and regulated by
fetal nervous system.
• Fetal CNS is very sensitive to diminished oxygenation.
• Hypoxia Metabolic acidosis CNS depression
Changes in fetal Biophysical activity.
Indications:
• Non reactive NST
• High risk pregnancy

Frequency:
• Weekly after a normal NST
• Twice weekly after abnormal NST
 Modified Biophysical Profile:

• Modified BPP consists of NST and Ultrasonographically determined

amniotic fluid index.
• With USG largest vertical pockets in 4 quadrants of uterine cavity are
measured. The sum of these 4 measurements (in cms) is the AFI.
• Modified BPP is considered abnormal when NST is non-reactive
and/or when AFI < 5cm.
 Biophysical Profile Scoring (Manning Scoring)
Normal score-2; Abnormal score-0

Parameters Minimal normal criteria Score

Non-stress test
Fetal breathing movements
Gross body movements
Fetal muscle tone
Amniotic fluid volume
Reactive pattern 2
i.e., ≥ 2 accelerations of ≥ 15 beats/min
for ≥15 sec within 20-40 mind
≥ 1 episode lasting ≥ 30 seconds within 2
30 mins
≥ 3 discrete body/limb movements 2
within 30 mins
≥ 1 episode of active exertion (limb or 2
trunk) with return of flexion; opening
or closing of hand considered normal
with in 30 mins
≥ 1 pocket measuring 2cm in two 2
perpendicular planes(2cm x 2cm
pocket)
 BPP Scoring, Interpretation and Management
BPP score Interpretation Management
8-10 Normal; less risk of fetal asphaxia Repeat testing at weekly interval
6 Suspect chronic asphaxia If ≥ 36 weeks, deliver;
But if L/S < 2.0 or <32 weeks repeat test
in 4-6 hours
4 or less Strongly suspect asphaxia Test for 120 mins

Persistent score of ≤ 4

Deliver regardless of gestational age

• Abnormal score of 4 or less is associated with fetal acidemia.
• Abnormal BPP is associated with high risk of still births and perinatal
mortality
• False negative rate of normal BPP is 0.1%
THANK YOU