7.1 Biophysical Profile Flashcards
what main fetal activity are we looking for with the BPP?
whats the fourth parameter we asses and measure?
do we document these findings?
- 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
what are the additional assessments that we do in a BPP?
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
what factors effect the BPP?
Asphyxia or low O2:
- extent
- duration
- frequency
Drugs:
- sedatives
- analgesics
- anesthetics
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
those that develop and mature first
first effected: fetal heart rate reactivity centre, which develops ~28wks
last effected: area that controls fetal tone
what does the term quickening refer to?
when does it occur?
when mom first perceived movement which happens around 20 wks
what is a non-stress test (NST)?
what specifically are we assessing with a NST?
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
main purpose of performing BPP?
check for fetal hypoxia
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?
2 for doing the required exercise
0 when no adequately performed
within 30 minutes
8 points
whats the criteria for scoring gross fetal movement?
3+ gross body movements in 30 mins (score of 2)
2 or less is a 0
whats the criteria for scoring fetal breathing?
30 seconds of continuous fetal breathing (Score of 2)… fetus can take one 6 second break
…hiccups count as breathing
is a 0/2 for fetal breathing a reliable indicator of poor fetal wellbeing?
no, fetus can have long periods of apnea and be normal
which element of the BPP is least common seen?
fetal breathing
whats the criteria for scoring fetal tone?
must show one episode of flexion and extension of a limb, phalanges or yawn (2/2)
no episode = 0/2
whats the criteria for scoring amniotic fluid?
do we include the cord when we measure the fluid?
pock of >/= 2X2 cm is norm (2/2)
anything less than this is (0/2)
NO
with what score will a patient have a NST?.. if we add this test, what is the BPP now out of?
<8/8
out of 10
in the fetus scored a 6/8 because of lack of breathing, in when would a NST not be recommended?
if the biometry of the fetus is normal
in the fetus scored a 6/8 because of lack of amniotic fluid, is this concerning? what are the next steps to take?
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
what is an amniotic fluid index (AFI) and how is it calculated?
why do we assess A-fluid levels?
- 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
when is the AFI performed and does it influence the BPP score?
during the BPP… doesnt change the score
what are maternal and fetal factors that can effect A-fluid levels? other factors?
M: maternal diabetes, high BP
F: renal abnormalities, swallowing probs
- PROM (concerning for infection of fetus)
- placental insufficiency
what does an AFI < 5cm indicate?
what does an AFI >20-25cm indicate?
<5cm: oligohydramnios
> 20-25cm: polyhydramnios (can lead to preterm labour)
how do you measure AFI?
does sequence matter?
vertical depth of the pock to floor
NO
with a NST, how should the fetal HR respond to fetal movement and rest? what does it indicate?
HR should increase with fetal movement and quick ly return to norm when movement stops… indicates fetal well being
signs of fetal distress with a NST
- heart is slow to return to norm when movement is stopped
- no change in HR with movement
- heart decelerations with activity
whats the criteria for scoring a NST?
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)
what is considered a good BPP score? with what score would you need to repeat the scan every 24hrs?
good: 8/10 or 10/10
repeat scan: 6/10 or 4/10
what does a score of 6/10-4/10 indicate about the uterine environment?
it may be compromising the fetus…. you must take maternal risk factors into account (high BP or type I diabetes)
what should be the next step with a score of 2/10 or 0/10?
delivery
when is a BPP performed? wks
why?
after 28 wks… centers of the brain needed for the assessment havent developed yet
what does it mean if a NST is reactive? non-reactive?
reactive= good non= bad
Is it always concerning if theres an absence of activity of the fetus? what can be norm causes of this?
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.
why is fetal doppler often performed during the BPP?
what can it help detect?
which vessel if most commonly dopplered?
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
what flow do we want to see in the umbilical artery (UA)?
when in gestation is the UA more restive and why?
high diastolic flow
When the fetus is younger.. b/c as fetus grows the UA gets larger which causes less resistance
what does low or absent diastolic flow in the umbilical artery indicate?
difficulty for fetus to return blood to the placenta or a high resistance bed…. also placental insuficiency
how long will the fetus live in the umbilical artery has reversed diastolic flow?
~24 hrs.. need to deliver
what are 3 factors effecting doppler waveform?
respiration
HR
blood viscosity (very thin) in very anemic fetuses
what value is used when reporting fetal doppler values?
pulsatility index (PI)
what abnormalities are a grade III placenta associated with? how will grade III appear on US
abnormal fetal HR and increased risk of abruption
bumpy or heterogenous instead of smooth
BPP was created based on which method of scoring newborns?
Apgar score
what are two assessments you would do before starting the BPP? what BPP assessment is good to start with?
assess fetal lie and check for fetal HB
breathing since fetus will be most active since mom has just been moving
why do we do biometry during a BPP?
fetal growth also indicates placental functioning
