Biophysical profile

Definition

• Ultrasound technique that provides an objective method of assessing risk of fetal death

Components

• Non-stress test: reactive
• Fetal respiration: at least 30 seconds
• Fetal movement: at least 3 body or limb movements
• Fetal tone: at least 1 flexion-extension
• Amniotic fluid: deepest vertical fluid pocket at least 2 cm

Related investigations

• Non-stress test (NST): 20 minutes of fetal heart monitoring with tocometry
• Contraction stress test: late decelerations associated with at least 50% of contractions over 20 minutes, if having 3 contractions in 10 minutes

History

• Improves the PPV of a non-stress test
• Developed by Platt and Manning in 1980
• Originally had 5 components
• Later studies found that NST did not add value and is not necessary

Indications

• High risk of stillbirth

Accuracy

• Limited by skill of the examiner
• Sensitivity
• Specificity
• LR+
• LR-

Result

• 6+/10 is normal
• 0-4/10 consider delivery
• Predicts perinatal morbidity
  • 8: 10%
  • 6: 30%
  • 4
  • 2
  • 0: 100%
• Predicts fetal acidosis

Modified BPP

• NST and AFI or maximal vertical pocket
• Faster
• Progress to full BPP if not full points