7.1 Biophysical Profile

Question 1

what main fetal activity are we looking for with the BPP?

whats the fourth parameter we asses and measure?

do we document these findings?

Answer 1

• gross body movements- moving the trunk or head
• breathing- practice breathing and/or hiccups
• fetal tone- flexion of limb, phalanges or yawn

4th: amniotic fluid

no, they are assessed in real time

Question 2

what are the additional assessments that we do in a BPP?

Answer 2

biometry (BPD, HC, AC (3 times), FL)
doppler of umbilical vessels
amniotic fluid level or index
placenta grade and position
cord position
M mode of heart
bladder, kidneys
assessing abnormalities previously seen

Question 3

what factors effect the BPP?

Answer 3

Asphyxia or low O2:

• extent
• duration
• frequency

Drugs:

• sedatives
• analgesics
• anesthetics

Question 4

in general, which centres in the fetal brain are last to be effected by low 02 levels?

specifically, which areas in the fetal brain and effect first and last by low 02

Answer 4

those that develop and mature first

first effected: fetal heart rate reactivity centre, which develops ~28wks

last effected: area that controls fetal tone

Question 5

what does the term quickening refer to?

when does it occur?

Answer 5

when mom first perceived movement which happens around 20 wks

Question 6

what is a non-stress test (NST)?

what specifically are we assessing with a NST?

Answer 6

a fetal HB monitor test that produces a tracing of the fetal heart.
done in labour and delivery or maternal fetal medicine departments….

the time it takes the heart to return to norm

Question 7

main purpose of performing BPP?

Answer 7

check for fetal hypoxia

Question 8

what are the possible scores given to the fetus for each BPP criteria? and what is the time frame?
how many points is it out of?

Answer 8

2 for doing the required exercise
0 when no adequately performed

within 30 minutes

8 points

Question 9

whats the criteria for scoring gross fetal movement?

Answer 9

3+ gross body movements in 30 mins (score of 2)

2 or less is a 0

Question 10

whats the criteria for scoring fetal breathing?

Answer 10

30 seconds of continuous fetal breathing (Score of 2)… fetus can take one 6 second break
…hiccups count as breathing

Question 11

is a 0/2 for fetal breathing a reliable indicator of poor fetal wellbeing?

Answer 11

no, fetus can have long periods of apnea and be normal

Question 12

which element of the BPP is least common seen?

Answer 12

fetal breathing

Question 13

whats the criteria for scoring fetal tone?

Answer 13

must show one episode of flexion and extension of a limb, phalanges or yawn (2/2)

no episode = 0/2

Question 14

whats the criteria for scoring amniotic fluid?

do we include the cord when we measure the fluid?

Answer 14

pock of >/= 2X2 cm is norm (2/2)
anything less than this is (0/2)

NO

Question 15

with what score will a patient have a NST?.. if we add this test, what is the BPP now out of?

Answer 15

<8/8

out of 10

Question 16

in the fetus scored a 6/8 because of lack of breathing, in when would a NST not be recommended?

Answer 16

if the biometry of the fetus is normal

Question 17

in the fetus scored a 6/8 because of lack of amniotic fluid, is this concerning? what are the next steps to take?

Answer 17

yes

first NST…. then:

• if preg is term, or post dates, delivery is recommended
• if preg is preterm, then bedrest and a follow up BPP to see if the levels improve

Question 18

what is an amniotic fluid index (AFI) and how is it calculated?
why do we assess A-fluid levels?

Answer 18

• assess the amount of fluid in the uterus and its calculated by adding together the depths of amniotic fluid in 4 quadrants of the uterus
• to assess the placental functioning

Question 19

when is the AFI performed and does it influence the BPP score?

Answer 19

during the BPP… doesnt change the score

Question 20

what are maternal and fetal factors that can effect A-fluid levels? other factors?

Answer 20

M: maternal diabetes, high BP
F: renal abnormalities, swallowing probs

• PROM (concerning for infection of fetus)
• placental insufficiency

Question 21

what does an AFI < 5cm indicate?

what does an AFI >20-25cm indicate?

Answer 21

<5cm: oligohydramnios

> 20-25cm: polyhydramnios (can lead to preterm labour)

Question 22

how do you measure AFI?

does sequence matter?

Answer 22

vertical depth of the pock to floor

NO

Question 23

with a NST, how should the fetal HR respond to fetal movement and rest? what does it indicate?

Answer 23

HR should increase with fetal movement and quick ly return to norm when movement stops… indicates fetal well being

Question 24

signs of fetal distress with a NST

Answer 24

• heart is slow to return to norm when movement is stopped
• no change in HR with movement
• heart decelerations with activity

Question 25

whats the criteria for scoring a NST?

Answer 25

minimum 2 episodes of acceleration of >15 bpm for at least 15 sec occurring with fetal movement in a 30 min period (score of 2/2)

Question 26

what is considered a good BPP score? with what score would you need to repeat the scan every 24hrs?

Answer 26

good: 8/10 or 10/10

repeat scan: 6/10 or 4/10

Question 27

what does a score of 6/10-4/10 indicate about the uterine environment?

Answer 27

it may be compromising the fetus…. you must take maternal risk factors into account (high BP or type I diabetes)

Question 28

what should be the next step with a score of 2/10 or 0/10?

Answer 28

delivery

Question 29

when is a BPP performed? wks

why?

Answer 29

after 28 wks… centers of the brain needed for the assessment havent developed yet

Question 30

what does it mean if a NST is reactive? non-reactive?

Answer 30

reactive= good
non= bad

Question 31

Is it always concerning if theres an absence of activity of the fetus? what can be norm causes of this?

Answer 31

no… could reflect long sleep cycles (more than 30 mins) or mom many have low blood sugar levels…. lack of activity is less concerning is the amniotic fluid levels are normal.

Question 32

why is fetal doppler often performed during the BPP?
what can it help detect?

which vessel if most commonly dopplered?

Answer 32

to assess the fetoplacental circulation

help detect:

• IUGR
• twin to twin transfusion
• fetal growth compromise due to maternal hypertension or insulin dependent diabetes mellitus

the umbilical artery

Question 33

what flow do we want to see in the umbilical artery (UA)?

when in gestation is the UA more restive and why?

Answer 33

high diastolic flow

When the fetus is younger.. b/c as fetus grows the UA gets larger which causes less resistance

Question 34

what does low or absent diastolic flow in the umbilical artery indicate?

Answer 34

difficulty for fetus to return blood to the placenta or a high resistance bed…. also placental insuficiency

Question 35

how long will the fetus live in the umbilical artery has reversed diastolic flow?

Answer 35

~24 hrs.. need to deliver

Question 36

what are 3 factors effecting doppler waveform?

Answer 36

respiration
HR
blood viscosity (very thin) in very anemic fetuses

Question 37

what value is used when reporting fetal doppler values?

Answer 37

pulsatility index (PI)

Question 38

what abnormalities are a grade III placenta associated with? how will grade III appear on US

Answer 38

abnormal fetal HR and increased risk of abruption

bumpy or heterogenous instead of smooth

Question 39

BPP was created based on which method of scoring newborns?

Answer 39

Apgar score

Question 40

what are two assessments you would do before starting the BPP? what BPP assessment is good to start with?

Answer 40

assess fetal lie and check for fetal HB

breathing since fetus will be most active since mom has just been moving

Question 41

why do we do biometry during a BPP?

Answer 41

fetal growth also indicates placental functioning