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Ob/Gyne > Module 7.1 : Biophysical Profile BPP > Flashcards

Module 7.1 : Biophysical Profile BPP Flashcards

1
Q

BPP

A

biophysical profile

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2
Q

what fetal biophysical activities can we identify on US

A
  • gross body movement
    + rolling of fetal trunk or turning of fetal head
  • breathing
    + just practice breathing motion (mom breathes for fetus) and hiccups
  • fetal tone
    + flexion and extension of a limb or fingers
  • 4th parameter is AMNIOTIC FLUID
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3
Q

additional assessments with BPP

A 
- biometry
   \+ BPD/HC
   \+ AC
   \+ FL
- doppler of umbilical artery (when under 50th percentile)
- amniotic fluid volume AFI
- placenta grade or position
- cord position
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4
Q

factors affecting BPP score

A
  • asphyxia

- drugs

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5
Q

asphyxia

A
  • low oxygen in fetus
  • extent or severity will result in low score
  • duration or length of time fetus has low oxygen
  • frequency of the insult (continuous or intermittent)
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6
Q

drugs that affect BPP

A
  • sedatives (barbiturates - opium)
  • analgesics (morphine)
  • anesthetics (halothane)
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7
Q

lack of oxygen on activity centres in brain

A
  • activity centres in the brain that mature first are the last to be affected when low oxygen occurs
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8
Q

fetal tone and lack of oxygen

A
  • area in the brain that controls fetal tone develops first and last activity to disappear in asphyxia
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9
Q

fetal heart rate and lack of oxygen

A
  • fetal heart rate reactivity centre matures at 28 weeks and first to be affected by asphyxia
  • monitored with non stress test (NST)
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10
Q

performing the BPP

A 
- observe movement
  \+ gross fetal movement 
  \+ fetal breathing
  \+ fetal tone
- measure
  \+ amniotic fluid pocket
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11
Q

purpose of BPP

A
  • performed to asses for fetal hypoxia
    + asphyxia
    + low oxygen levels in the fetus
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12
Q

scoring of a BPP

A 
- for each criteria fetus gets a score
   \+ 2 = does required exercise
   \+ 0 = element not performed
- fetus allows 30 minutes to perform all elements 
- just US BPP out of 8
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13
Q

gross fetal movement

A
  • 3 or more gross fetal movements must be seen in 30 minutes to give a score of 2
  • if any fewer than gets a 0
  • movement = fetal trunk or head moves
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14
Q

fetal breathing movement

A
  • 30 seconds of continuous fetal breathing is requires to get score of 2
  • fetus can take one 6 second break in the 30 seconds
  • hiccups count
  • score of zero not reliable indicator of poor fetal well being as they may have long stretches of apnea
  • either 2/2 or 0/2
  • most frequently not seen on BPP
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15
Q

fetal tone

A 
- fetus most demonstrate one episode of flexion and extension
  \+ arm
  \+ leg
  \+ finger
   \+ toe
  \+ yawn
- 2/2 or 0/2
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16
Q

amniotic fluid pocket

A
  • a pocket >/= 2x2 cm is normal and given a score of 2
  • anything less is score of 0
  • do not include cord in this measurement
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17
Q

the score

A
  • if fetus performs in all of the US criteria it is given a score of 8/8
  • if one or more is missed in 30 minute exam it is given 6/8 or 4/8
  • patient will go on to have a non stress test
  • NST performed in labor and delivery or MFM
  • BPP now out of 10
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18
Q

are all scores equal ?

A
  • no
  • a 6/8 because of lack of fetal breathing is not as concerning
    + NST recommended bust maybe not is growth is normal
  • a 6/8 because of lack of amniotic fluid is concerning
    + is pregnancy is post does delivery is recomendded
    + is preterm then bedrest and follow up BPP
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19
Q

amniotic fluid index AFI

A
  • method of assessing amount of amniotic fluid in amniotic sac around fetus
  • AFI performed during BPP
  • does not influence BPP score at all
  • amniotic fluid levels help assess placental function
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20
Q

factors affecting AFI

A 
- maternal 
  \+ diabetes
  \+ high blood pressure
- fetal
  \+ renal abnormalities
  \+ swallowing difficulties
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21
Q

how to evaluate AFI

A
  • sum of depth of all amniotic fluid in 4 quadrants of uterus
22
Q

oligohydramnious

A

AFI < 5cm

23
Q

polyhydramnios

A

AFI > 20-25

24
Q

uterus quadrants

A
  • measure vertical depth to the floor
  • sequence does not matter
  • RLQ, LLQ, RUQ, LUQ
25
Q

any one pocket greater than 8 cm

A

polyhydramnios

26
Q

non stress test NST

A
  • tracing of fetal heart taken via electrodes on maternal abdomen over area of fetal heart
  • not an US test
  • ## performed by obstetrician or fetal assessment nurse
27
Q
  • what NST is looking for
A
  • increased heart rate with fetal motion with quick return to baseline when activity stops is good indication
  • the time it takes for the heat to return the normal is assesed
28
Q

signs of fetal distress

A
  • slow response of fetal heart to return to normal
  • no change in fetal heart rate with activity
  • heart rate decelerations
29
Q

assessing fetal distress

A
  • at least 2 episodes of acceleration over 15 bpm and at least 15 seconds duration associated with fetal movement in a 30 minute period
  • 2 is added to BPP score making it out of 10
30
Q

8/10 or 10/10

A
  • fetal well bein
31
Q

6/10 or 4/10

A
  • repeat scan in 24 hours
  • case per case conditions
    + high risk pregnancies with maternal factors or diseases must be considered
    + may indicate uterine environment harming fetus
    + fetal doppler performed on most of these for further information
32
Q

0/10 0r 2/10

A

delivery

33
Q

what is the apporpraite gestational age to start doing a BPP

A

not done prior to 28 weeks

34
Q

is the score alone a indicator of fetal well being

A

no

35
Q

factors that affect amniotic fluid

A

PROM
+ premature rupture of membranes
placental insufficiency

36
Q

what does a more BPP indicate

A
  • presense of normal biophysical activity indicates that CNS that controls activity is functioning well = non hypoxic
37
Q

fetal doppler

A
  • often performed during a BPP
  • assess the fetoplacental circulation in a non invasive manner
  • umbilical artery is most common vessel to doppler
38
Q

poor doppler results detect

A
  • IUGR = intrauterine growth restriction
  • twin to twon transfusion
  • fetal growth compromise due to maternal hypertension IDDM (insulin dependent diabetes mellitus)
39
Q

normal doppler - umbilical artery

A
  • high diastolic flow in umbilical artery
40
Q

absent diastolic flow indicates

A
  • difficulty for fetus to return blood to placenta or high resistance bed
  • placenta insufficiency or high vascular resistance
41
Q

reversed diastolic flow

A
  • very worrisome
  • can indicate immediate delivery is necessary depending on gestational age
  • baby heart has to pump twice as hard
42
Q

factors affecting doppler wave form

A
  • fetal respirations
    + waveform cannot be assessed when fetus breathing
  • heart rate
    + tachycardia or bradycardia
  • blood viscosity (hematocrit) is severely anemic in fetuses
43
Q

umbilical artery flow

A
  • becomes less resistive as pregnancy advances in normal states
  • as vessel gets larger as pregnancy progresses
  • blood flow is less resistive
44
Q

pulsatility index

A
  • PI

- used in reporting fetal doppler values

45
Q

placenta

A
  • not a criteria for BPP but needs to be assessed for abruption and grade
46
Q

grade III placenta

A
  • associated with abnormal fetal heart rates and increased risk of abruption
  • normal in aging placenta in late 3rd trimester
    + if seen earlier is concerning
    + mom may be a smoker
47
Q

sleeping babies

A
  • in a 30 minute continuous scan a fetus may be quite inactive
  • if amniotic fluid is normal this is less worrisome because the fetus is just sleeping NST performed
  • ask mom when she last ate
48
Q

timing of BPP

A
  • observe the time you start BPP on machine clock
  • assess fetal lie first
  • check for fetal heart rate
  • observe breathing
    + watch for 30 seconds before moving onto measurements
    + if fetus not breathing then continue on but check for breathing in-between
49
Q

measurements taken in BPP

A
  • BPD
  • HC
  • AC x 3
  • FL
  • fetal growth also represents placental function
50
Q

other views in BPP

A
  • mmode of heart
  • bladder kidney
  • placenta
  • assessment of any abnormalities previously documneted
    + fetus with dilated kidneys = must measure again
    + fetus with dilated bowel = must measure again
51
Q

images for parents

A
  • DO NOT giver images to parents with measurements or callipers
  • DO NOT include repot for the parents

Ob/Gyne (24 decks)

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