Biophysical

Profile
 • Scoring system
• 2 points for:
What is a • Breathing
• Movement
BPP • Tone
• AFV
• NST
 1) Cardioregulatory neurons
 control the coupling of
fetal movement and heart
Oxygen rate acceleration
Sensitive
Centers 2) Fetal breathing center
neurons  control fetal
breathing movements
 Fetal breathing and FHR accels: affected by
hypoxemia

What gets Fetal movement: higher threshold before being

effect by hypoxemia
affected by Fetal tone center: highest threshold
hypoxemia?
 the sequence of change is clinically informative
as allows for estimation of presence and severity
 • For those at risk of stillbirth due to maternal,
fetal, obstetric comorbidities
Why do we
• Start at a gestational age where intervention
order BPP ? with delivery would be considered if the BPP
is abnormal
 • Acute parameters: FHR accels, breathing,
movement, tone
What to • Sleep is benign, but unusual to have 2+ acute
think about parameters absent due to sleep
• Think about drugs that can cause general
when acute brain suppression, ex: sedatives and opiates

parameters • The lower the BPP, the less likely the changes
are due to sleep state
are absent? • The longer the acute parameters are absent,
the more likely to be pathologic
 • Nonacute parameter, as changes in
response to chronic uteroplacental
vascular insufficiency usually are
gradual
AFV changes – • Hypoxemia induced redistribution
of CO away from kidneys 
chronic diminished urine production 
parameters oligo  anhydramnios
• Average 15 days to progress from
normal fluid to reduced AFV and 23
days for severe oligohydramnios
 >8

• Strong indicator that fetal oxygen

levels and acid-base status are
normal
• Well perfused fetal brain and normal
Scores oxygenation

<4

• Can be indicatory of fetal

compromise
• if ID, can intervene
 Time to observe

Should observe for at Average time to obtain

least 30 mins before normal BPP score is 5.3
giving a score of 0 minutes
 Only looks at AFV and NST

Modified Found to be as reliable long term

BPP predictor as full BPP

Rate of stillbirth w/in 1 week of

normal modified BPP same as full
BPP 0.8/1000 women
Score
10/10, 8/8, 8/10 with normal AFV
6/10 with normal fluid
6/10 or 8/10 with oligo
0 – 4/10
What it means
- NORMAL test
- Risk of fetal death w/in 1 week if not delivered is LOW (0.4-0.6/1000 births)
- BPP 8/10 with any combo of parameters is as reliable as 10/10 as long as points
not lost of AFV
- Fetal death after normal BPP usually from acute unpredictable insult (cord
prolapse, hemorrhage, abruption)
- Equivocal test because sig possibility of developing fetal asphyxia cannot be
excluded
- Repeat w/in 24 hours to see if the absent acute parameter returns to normal
- If near term/term, consideration for delivery
- ABNORMAL test
- Risk of fetal asphyxia w/in 1 week if 89/1000
- ABNORMAL
- Risk of fetal asphyxia w/in 1 week if 91-600/1000 if no intervention
What can affect BPP ?
• Meds, Exposures, GA
Exposure Impact

Antenatal steroids - Associated with transient FHR and behaviour changes

- Usually return to baseline by post tx day 4
- Breathing and movement can be reduced

Subclinical infection - Controversial if inpact

- Intraamniotic infection in PPROM may be assoc with low BPP in absence of hypoxemia
Preterm labour - May be associated with absent breathing
- Absent breathing not a good predictor of preterm delivery w/in 48 hours or seven days
Fasting - Small study, 2 fasting BPP were abN then after meal were normal
- diff to draw conclusions
- “try juice”
Anemia - Does not appear to impact
Obstetric Perinatal mortality and
Imaging: morbidity is inversely
proportional to BPP
Fetal score
Diagnosis
and Care 2nd Delivery usually
edition, 2018 indicated when BPP
page 537-540 <4/10
 Rate of fetal death
after last normal test
Manning, 0.726 per 1000
1987 Mean interval
between last test and
death is 4.4 days
How often
to do?
NORMAL BPP REPEATED WEEKLY OR
TWICE WEEKLY UNTIL DELIVERY IF HIGH
RISK CONDITION IS PRESENT BUT STABLE
SEVERE GROWTH RESTRICTION
REQUIRES MORE FREQUENT
MONITORING
 Limited high-quality studies

No RCT
Evidence
for Observational studies:

• BPP accurate to predict absence of sig

monitoring? fetal acidemia
• When BPP falls, mortality and morbidity
increases
• Inverse relationship b/w last BPP score
and incidence of CP