| Biophysical profile | |
| Purpose: | prenatal evaluation ultrasound |
| Synonyms: | BPP |
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.
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:
| 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 | |
| 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 movements | |
| US: Fetal muscle tone | At least one 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 |
Use of vibroacoustic stimulation to accelerate evaluation has been described.[4]
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.
| BPP | Recommended management |
|---|---|
| ≤2 | |
| 4 |
|
| 6 |
|
| ≥ 8 |
|