BPP Flashcards
What are the 4 fetal biophyscial activities that can be identified on US?
- Gross body movements
- Breathing
- Fetal tone
- Amniotic fluid
What additional assessments are included in the BPP? (5)
Biometry Flow in umbilical vessels Amniotic fluid volume or AFI Placenta grade and position Cord postion
What are the 2 main factors affecting BPP?
- Asphyxia (lack of oxygen)
2. Drugs
What is assessed in asphyxia?
Extent, duration and freq of insult
What sort of drugs can affect the BPD? (3)
- Sedatives (barbituates-opium)
- Analgesics (morphine)
- Anesthetics (halothane)
Which fetal activity develops first?
Fetal tone center
Which activity centre is the last affected by worsening asphyxia?
Fetal tone center
At what week does the heart rate reactivity develop?
28 weeks
Which activity centre is the first to be affect by asphyxia?
Heart rate reactivity
What should be seen within 30min of performing a BPP?
- Gross fetal development
- Fetal breathing
- Fetal tone (lips move, flexing, grabbing)
- Amniotic fluid pocket
Is a non stress test preformed by US?
No
What is the BPP used to assess?
Fetal hypoxia
For each criteria of the BPP the fetus is given a score, what is it?
2 for doing the required exercise
0 is not adequately preformed
What is the potential score for the BPP?
8
What is the potential score for the non stress test?
10
How many movements are required to be seen in 30min (For fetal movement)
3 or more
What is the score of the gross fetal movement when if there are 2 or less movements in 30min?
0
What is considered a gross body movement?
Head or trunk movement
How many seconds are required to get 2 points on fetal breathing movements?
30 seconds
Is the fetus allowed to take a breathing break within the 30 seconds? How long?
Yes and for 6 seconds
Do hiccups count in fetal breathing?
Yes
Is the score of zero a reliable indicator of poor fetal wellness?
No, the fetus may have long episodes of apnea and still be normal
Which is the most common element we do not see the fetus preform?
Fetal breathing movements
How many movements of fetal tone must be demonstrated to get a score of 2?
One episode of flexion and extension
What are examples of flexion and extension?
Arm, leg, toe movement or yawn
What is the required size of pocket of fluid seen when assessing the amniotic fluid?
> or equal to 2X2 cm
Do you include the spinal cord within in the measurement when assessing the amniotic fluid?
No
What is the amniotic fluid volume/index (AFI) used to assess?
Amount of fluid in the uterus
When is the AFI examined?
During the BPP assessment
Does the AFI affect the BPP score?
No
What does the AFI help assess?
Placental function
Why would we want to know placenta function?
It is affected by maternal factors which can affect the amniotic fluid levels
How is the AFI calculated?
The sum of all 4 quadrants
What is it called when the AFI is < 5cm?
Oligohydramnios
What is it called when the AFI is > 20-25cm
Polyhydramnios
Where do you place the calibers when measuring the quadrants?
Vertical depth- measure top to bottom (to the floor)
When do patients have to go for a NST?
When the fetus score is < 8
When is the score of 6/8 concerning?
When theres an absent of amniotic fluid
If due date past delivery is recommended
If preterm bedrest is recommended
What is a NST?
A tracing of the fetal heart via electrodes placed on maternal abdomen over the area of the fetal heart
Where is the NST preformed?
Fetal assessment units or labour and delivery units
Who preforms the NST?
Obstetrician or fetal assessment nurse
What is a indication of good fetal health on the NST?
Increased HR with fetal motion, with a quick return to base
What are signs of fetal distress in the NST? (3)
- Slow response of heart to return to normal
- No change in HR with activity
- HR decelerations
What is assessed in the NST?
- 2 episodes of acceleration of > 15b/m
- 15sec duration associated with fetal movement
- All in a 30min period
What can cause the BPP score to be 4/10 or 6/10?
High risk pregnancies
maternal factors or dx must be considered (HBP & type 1 diabetes
Case per case conditions
When do you repeat the scan when the BPP score is 4/10 or 6/10
Repeat scan in 24hrs
When is the BPP scan done?
28weeks
What are the factors that might affect amniotic fluid? (2)
- Premature rupture of membranes
2. Placenta insufficiency
Why is premature rupture of the membranes concerning?
Concerning for infections of the fetus
Why is insufficiency of placental function concerning?
Concerning for poor fetal growth and poor outcome
US alone 8/8 includes…
Breathing, movement, tone and amniotic fluid > 2cm
Is an 8/10 NST reactive?
Yes
Is an 6/10 NST reactive?
Non, non-reactive
When is fetal doppler preformed?
During the BPP scan
What does fetal doppler used to assess?
Fetoplacental circulation
What can fetal doppler detect? (3)
- IURG
- Twin to twin transfusion
- Maternal hypertension
What is the most common vessel to doppler?
Umbilical artery
Refer to pg 26 and 27 regarding doppler flow waveforms…
Refer to pg 26 and 27
What does low or absent diastolic doppler flow indicate?
Difficultly for fetus to return blood to placenta or a high resistance bed
What does a reversed diastolic doppler flow indicate?
Delivery is necessary depending on fetal age
Fetal demise within 24hrs if you see this waveform
What are factors that affect doppler waveform? (3)
- Respirations
- HR
- Blood viscosity (hematocrit)
What happens to the umbilical blood flow as the pregnancy advances?
The vessel becomes larger and less resistive
What value is used in reporting fetal doppler values?
PI or pulsatility index
Why should the placenta be assessed?
For abruption and grade
What is a grade 3 placenta associated with?
Abnormal fetal heart rates and increased risk of abruption
How should a normal placenta appear?
Should look like the liver
What is the Apgar scoring?
A score given to the baby when born
When are the best biophysical scores taken?
After the mother has eaten
Explain the timing of the BPP
- Observe the time you started
- Assess fetal lie first
- Second check for fetal HR
- Third observe fetal breathing (if baby doesn’t breath right away cont. with exam)
What are the measurements taken at fetal assessment? (4)
- BPD
- HC
- AC X 3
- FL
What are other views taken besides the BPP views?
- M-mode of the heart
- Bladder/kidneys
- Placenta
- Assessment for any abnormalities previously documented (fetus with dilated kidneys or distended bowel)
