Fetal surveillance - BPP

Question 1

Biophysical profile is a test used to evaluate what?

Answer 1

Well-being of the fetus

Question 2

Biophysical profile uses what to examine the fetus?

Answer 2

Ultrasound and cardiotocography (CTG), also known electronic fetal heart rate monitoring

Question 3

Components of BPP

Answer 3

• Fetal tone
• Fetal breathing
• Fetal movement
• Amniotic fluid volume
• Non-stress test

Question 4

The test is continued until ____

Answer 4

All criteria are met or 30 minutes have elapsed

Question 5

Normal findings for each criterion

Answer 5

• Fetal tone
  
  • One or more episodes of active extension and flexion of a fetal extremity or opening and closing of the hand within 30 minutes
• Fetal breathing
  
  • One or more episodes of fetal breathing lasting at least 30 seconds within 30 minutes.
• Fetal movement
  
  • 3 or more discrete body or limb movements within 30 minutes
• Amniotic fluid volume
  
  • A single deepest vertical pocket of amniotic fluid measures greater than 2 centimeters is present
• Non-stress test
  
  • Reactive
  • Two or more fetal heart rate accelerations that peak at least 15 beats per minute above the baseline and last at least 15 seconds from baseline to baseline during 20 minutes of observation
• Memory aid:*
• TB MAN - 1-1-3-2-2 (reactive)

Question 6

BPP scores and management

Answer 6

• 10
  
  • Normal, nonasphyxiated fetus
    
    • No fetal indication for intervention
    • Repeat test weekly (or twice weekly in diabetics and postterm)
• 8/10 (Normal AFV)
  
  • Normal, nonasphyxiated fetus
    
    • No fetal indication for intervention
• 8/8 (NST not done)
  
  • Normal, nonasphyxiated fetus
    
    • No fetal indication for intervention
• 8/10 (Decreased AFV)
  
  • Chronic fetal asphyxia suspected
    
    • Deliver
• 6
  
  • Possible fetal asphyxia
    
    • If AFV abnormal, deliver
    • If normal fluid at > 36 weeks with favorable cervix, deliver
    • If repeat ≤ 6, deliver
    • If repeat > 6, observe and repeat
• 4
  
  • Probable fetal asphyxia
    
    • Repeat testing same day
    • If ≤ 6, deliver
• 0 - 2
  
  • Almost ceetain fetal asphyxia
    
    • Deliver

Question 7

Arya, 37 weeks AOG had a BPP of 6/8. Fetal movement was zero. IE: 4 cm, 70%, station -3, ⊕ BOW with irregular contractions. Which is the best management of the case?

1. Advise for repeat UTZ on next visit
2. Repeat UTZ the same day; if same result, perform CS
3. Perform emergency CS
4. Admit for induction of labor

Answer 7

Answer: 4

Question 8

Components of modified BPP

Answer 8

1. nonstress test (NST)
2. amniotic fluid volume

Question 9

Interpretation of findings in MBPP

Answer 9

• normal if the NST is reactive and the deepest vertical pocket of amniotic fluid is greater than 2 centimeters
• abnormal if either the NST is nonreactive or the deepest vertical pocket of amniotic fluid is 2 cm or less