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    Fetal Biophysical Profile (BPP) Score

    Predicts need for urgent delivery based on sonographic and nonstress testing.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use
    • Use in pregnant patients, generally in the third trimester.
    • Should be administered by users familiar with interpretation of fetal heart rate monitoring and fetal ultrasound.
    • Indicated in pregnancies with risk of antepartum fetal demise, including maternal conditions (e.g. antiphospholipid syndrome, poorly-controlled hyperthyroidism) and pregnancy-related conditions (e.g. gestational hypertension, intrauterine growth restriction). For full list, see ACOG Practice Bulletin, Antepartum Fetal Surveillance (box 1, page 186).
    • Nonstress test can be omitted and presumed normal if all four sonography parameters are normal (2 points for each).
    • Of five fetal parameters, four are acute (nonstress test, fetal breathing, fetal movement, and fetal tone) and one is chronic (amniotic fluid volume).

    Helps determine if emergent delivery is required.

    <30 sec of breathing within 30 min
    0
    ≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min
    +2
    <3 discrete movements
    0
    ≥3 discrete body or limb movements within 30 min
    +2
    0 extension/flexion events
    0
    ≥1 episode of extremity extension and subsequent return to flexion
    +2
    Largest single vertical pocket ≤2 cm
    0
    A pocket of amniotic fluid ≥2 cm in 2 perpendicular planes (2x2 cm pocket)
    +2

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Critical Actions

    Consult neonatology if fetal asphyxia is suspected.

    Formula

    Addition of the selected points:

     

    0 points

    2 points

    Fetal breathing

    <30 sec of breathing within 30 min

    ≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min

    Fetal movement

    <3 discrete movements

    ≥3 discrete body or limb movements within 30 min

    Fetal tone

    0 extension/flexion events

    ≤1 episode of extremity extension and subsequent return to flexion

    Amniotic fluid volume*

    Largest single vertical pocket ≤2 cm

    A pocket of amniotic fluid ≥2 cm in 2 perpendicular planes (2x2 cm pocket)

     Nonstress test**

    0 or 1 acceleration within 20–40 min

    ≥2 accelerations of ≥15 beats/min for ≥15 sec within 20–40 min 

    *If largest vertical amniotic fluid pocket ≤2 cm.

    **May omit if all four sonographic components are normal.

    Facts & Figures

    Interpretation:

    BPP Score

    Interpretation

    Recommendation

    10

    Normal, non-asphyxiated fetus

    No fetal indication for intervention; repeat test weekly except in diabetic patients and post-term pregnancy (twice weekly)

    8/10, Normal AFV

    Normal, non-asphyxiated fetus

    No fetal indication for intervention; repeat testing per protocol

    8/8, NST not done

    Normal, non-asphyxiated fetus

    No fetal indication for intervention; repeat testing per protocol

    8/10, Decreased AFV

    Chronic fetal asphyxia suspected

    Deliver

    6

    Possible fetal asphyxia

    If abnormal AFV, deliver. If normal AFV, delivery recommended if >36 weeks with favorable cervix or repeat test ≤6; if repeat test >6, observe and repeat per protocol

    4

    Probable fetal asphyxia

    Repeat testing same day; if ≤6, deliver

    0–2

    Almost certain fetal asphyxia

    Deliver

    From Manning 1980.

    Evidence Appraisal

    The Biophysical Profile (BPP) was proposed by Manning in 1980. He derived and applied the BPP to 216 high-risk pregnancy patients and compared their perinatal outcomes. Results suggested that BPP can be an accurate method of antepartum fetal evaluation.

    A subsequent study was performed in 2,712 patients receiving 7,851 tests of BPP evaluation but with reduced use of non-stress test (NST). Results showed no measurable change in test accuracy if other four ultrasound parameters are normal. Therefore, NST can be omitted and presumed normal if ultrasound parameters are normal (Manning 1987).

    Kim et al validated the BPP Score in 100 patients with singleton pregnancies in active labor phase. Results showed that BPP is a good predictor for cesarean delivery and need for NICU admission. The use of oxytocics, prostaglandins, or epidural anesthesia did not influence BPP score (Kim 2003).

    A modified BPP exists, which takes less time to perform and seems to have similar accuracy in predicting perinatal outcome (Nagoette 1994). Still, the full BPP provides more detailed information to help decision-making when facing suspected fetal distress.

    Dr. Frank A. Manning

    About the Creator

    Frank A. Manning, MD, is a professor of obstetrics and gynecology and associate director of the maternal-fetal medicine division at New York Medical College. His research interests include fetal ultrasound and in utero fetal therapy. Dr. Manning is the author of seven books including Sonography in Obstetrics & Gynecology Principles and Practice.

    To view Dr. Frank A. Manning's publications, visit PubMed

    Content Contributors
    • Nai-Ming Cheng, MD
    About the Creator
    Dr. Frank A. Manning
    Content Contributors
    • Nai-Ming Cheng, MD