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Biophysical profile of the fetus, its definition and evaluation. Determination of the biophysical profile of the fetus Cure bfp published fields are marked

Biophysical profile of the fetus- a complex of studies, including physical activity, respiratory movements, heart rate, fetal tone and the amount of amniotic fluid, which allows you to objectify the condition of the fetus.

Test Method:
a) a non-stress test is performed (see question non-stress test)

b) the fetus is observed using real-time ultrasound for 30 minutes in order to identify criteria (see table). It is better to conduct the study after eating.

Test interpretation:
a) normal test - the number of points 10-8 (out of 10 possible)

b) suspicious - 6-7 points, i.e. chronic asphyxia is possible and the test must be repeated within 24 hours

c) less than 6 points - a serious risk of chronic hypoxia, which requires a repetition of the non-stress test immediately and if the result is the same, then an emergency delivery is necessary

d) any number of points less than 10 with the presence of oligohydramnios - an indication for immediate delivery (if oligohydramnios is not associated with rupture of the membranes).

Criteria for evaluating the biophysical profile

Parameter 2 points 1 point 0 points
Non-stress test 5 accelerations and more with an amplitude of at least 15 beats / min. duration of at least 15 s, associated with the movement of the fetus, for 20 minutes of observation 2-4 accelerations with an amplitude of at least 15 beats / min. lasting at least 15 s, associated with the movement of the fetus. for 20 minutes of observation 1 acceleration or lack thereof in 20 minutes of observation
Respiratory movements of the fetus At least 1 episode of DDP lasting 60 seconds or more in 30 minutes At least 1 episode of DDP lasting 30 to 60 seconds in 30 minutes Duration< 30 с или их отсутствие за 30 мин
Fetal activity At least 3 generalized movements in 30 minutes 1 or 2 generalized movements in 30 minutes Lack of generalized movements
Fetal tone 1 episode or more of extension with a return to the flexion position of the spine and limbs in 30 minutes At least 1 episode of extension with a return to the flexion position of either the limbs or the spine in 30 minutes Limbs in flexed position
Volume of amniotic fluid The waters are clearly defined in the uterus, the vertical diameter of the free area of ​​the waters is 2 cm or more The vertical diameter of the free water area is more than 1 cm, but less than 2 cm Close arrangement of small parts of the fetus. vertical diameter of free water area less than 1 cm

Benefits of the test:

a) can be performed on an outpatient basis

b) low false positive rate (compared to non-stress test)

c) no contraindications

d) can be used at the beginning of the third trimester of pregnancy

Disadvantages of the test:

a) requires the skill of an ultrasound specialist

b) requires more time (45-90 minutes).

Electrocardiography and fetal phonography.

Electrocardiography: direct and indirect.

a) Direct electrocardiography produced directly from the head of the fetus during childbirth with the opening of the cervix by 3 cm or more. An atrial P wave, a ventricular QRS complex, a T wave are recorded. Rarely performed.

b) Indirect electrocardiography carried out when electrodes are applied to the anterior abdominal wall of a pregnant woman (the neutral electrode is located on the thigh). This method is used mainly in the antenatal period. Normally, the ventricular QRS complex is clearly visible on the ECG, sometimes the P wave. Maternal complexes are easy to differentiate with simultaneous recording of the mother's ECG. The fetal ECG can be recorded from the 11th - 12th week of pregnancy, but in 100% of cases it can be recorded only by the end of the third trimester. As a rule, indirect electrocardiography is used after 32 weeks of pregnancy.

Phonocardiogram (PCG) the fetus is recorded when the microphone is applied to the point of best listening with a stethoscope of its heart sounds. It is usually represented by two groups of oscillations, which reflect the I and II heart sounds. Sometimes III and IV tones are registered. Fluctuations in the duration and amplitude of heart sounds are very variable in the III trimester of pregnancy and average: I tone - 0.09 s (from 0.06 to 0.13 s), II tone - 0.07 s (from 0.05 to 0 .09 s).

With simultaneous recording of the ECG and FCG of the fetus, it is possible to calculate the duration of the phases of the cardiac cycle: the phase of asynchronous contraction, mechanical systole, general systole, diastole. The phase of asynchronous contraction is detected between the beginning of the Q wave and I tone, its duration is 0.02-0.05 s. Mechanical systole is the distance between the beginning of I and II tone and lasts from 0.15 to 0.22 s. The general systole includes a mechanical systole and an asynchronous contraction phase; it is 0.17-0.26 s. Diastole, calculated as the distance between the beginning of II and I tone, is 0.15-0.25 s. It is also important to calculate the ratio of the duration of the total systole to the duration of the diastole, which at the end of an uncomplicated pregnancy averages 1.23.

Cardiotocography.

Cardiotocography (CTG) of the fetus - the most accessible, reliable and accurate method for assessing the condition of the fetus during the last trimester of pregnancy. The cardiotocograph is designed in such a way that it simultaneously registers fetal heart rate, uterine contractions and fetal movement. Currently, screening controls for the condition of the fetus will be carried out both on an outpatient basis and in a hospital. In risk groups for perinatal losses, screening control is carried out in dynamics. Usually, fetal heart rate registration is used from 30 ice. pregnancy on a tape moving at a speed of 10 to 30 mm / min, for at least 30 minutes.

To characterize the condition of the fetus using CTG, the following indicators are used: basal heart rate, basal rate variability, frequency and amplitude of oscillations, amplitude and duration of accelerations and decelerations, fetal heart rate in response to contractions, fetal movements and functional tests.

a) Basal rhythm (BR) - long-term change in heart rate. Its decrease below 110 beats / min is classified as bradycardia, and an increase of more than 160 beats / min is classified as tachycardia. Therefore, a long-term heart rate in the range of 110-160 beats / min is regarded as a normal area. Tachycardia according to severity is distinguished: mild (160-170 beats / min) and severe (more than 170 beats / min). Bradycardia is also divided into mild (110-100 bpm) and severe (less than 100 bpm) severity. If bradycardia manifests itself in a time interval of no more than 3 minutes, and then it returns to the original BR, then it is called deceleration.

b) Variability characterized by an instantaneous frequency or short-term fluctuations in heart rate, corresponding to the time interval between two consecutive heartbeats. To the naked eye, these slight changes in short-term variability are not noticeable with other standard information. They are evaluated using computer systems. In practice, when assessing the condition of the fetus, it is always long-term or slow variability that is referred to as oscillation. Oscillations are periodic deviations from the average level of BR, which are based on instantaneous contractions of the heart muscle from beat to beat. This long-term variability is characterized by the amplitude and frequency of the oscillations.

c) amplitude, or the width of the record, counted between the maximum and minimum deviations in heart rate within 1 min. It is expressed in beats per minute. Depending on the magnitude of the amplitude, the following types of oscillations are distinguished:

"mute" or monotonous type (deviations from the basal level are 5 or less beats per minute);

"slightly undulating" - 5-9 beats / min

"undulating" (uneven, intermittent) type, when short-term periods with a decrease in the amplitude of slow oscillations are repeatedly interrupted by normal CTG and flattening periods exceed 10 minutes (deviations from the basal level within 10-25 beats / min);

"saltatory" (jumping) type, often combined with a high frequency of oscillations (deviations from the basal level of more than 25 beats / min).

d) Oscillation frequency determine the number of intersections of the line drawn through the middle of the oscillation in 1 minute. The following types of BR variability are distinguished by frequency:

Low (less than 3 oscillations per minute),

Moderate (from 3 to 6 oscillations per minute),

High (over 6 oscillations per minute). Tachycardia is characterized by an increase in heart rate for 10 minutes or more. If the heart rate increases in a time interval of up to 10 minutes, it is called acceleration. With accelerations, there is a short-term increase in heart rate by at least 15 beats / min for a period of time of at least 15 s.

Accelerations are divided into sporadic and periodic. sporadic accelerations arise in connection with the movements of the fetus or under the influence of an exogenous stimulus. Periodic accelerations occur during at least three consecutive contractions. The occurrence of acceleration before or after variable decelerations is regarded as primary and compensatory gachycardia.

Decelerations mean passing decelerations of the heart rate below the level of the average basal rate with an amplitude of at least 15 beats / min and for a time of 10 s or more.

There are 4 types of decelerations:

ü peaked- occurs sporadically or periodically, the fall and recovery of cardiac activity occurs abruptly, its duration is 20-30 s, the amplitude is 30 beats / min or more;

ü early deceleration- has a gradual beginning and end, the decrease in heart rate coincides in time with the peak of the contraction, its amplitude is proportional to the strength of the contraction, the total duration is up to 50 s;

ü late deceleration characterized by a delay in the decrease in heart rate relative to the onset of contractions, the onset is gradual, the apex is smooth, the recovery period for BR is more gentle, the total duration is more than 60 s;

ü variable deceleration indicates variability in the configuration of the wave in a different time relationship with the onset of the contraction, its shape, duration, start and recovery times may not be repeated, its amplitude ranges from 30 to 90 beats / min, the total duration is 80 s or more.

To assess the condition of the fetus according to CTG, a scoring system is used to interpret the nature of cardiac activity. On a 10-point scale, fetal cardiac activity is assessed according to the following parameters: basal frequency, amplitude of oscillation, frequency of oscillation, acceleration, deceleration. Each feature is scored from 0 to 2 points. A score of "0" points reflects the pronounced signs of fetal suffering, 1 point - initial signs of fetal suffering, 2 points - normal parameters.

The biophysical profile of the fetus is a comprehensive assessment of the data of a stress-free test and real-time ultrasound, which makes it possible to judge the condition of the fetus.

The biophysical profile of the fetus includes five parameters, evaluated on a two-point system. A score of 6 or more points is considered satisfactory. Sometimes a 6th parameter is added - the maturity of the placenta.

  • Breathing movements. The fetus makes respiratory movements episodically: there are several movements in a row, followed by a break. Normally, at least one episode of respiratory movements lasting 30 seconds for 30 minutes is recorded.
  • Fetal movements. The fetus must make at least three pronounced movements within 30 minutes (simultaneous movements of the limbs and torso are considered one movement).
  • Fetal tone - at least one episode of movement of the limbs from a flexion to an extended position and a rapid return to its original state (within 30 minutes).
  • Fetal reactivity (non-stress test) - the presence of two or more periods of heart rate acceleration with an amplitude of at least 15/min and a duration of at least 15 s, associated with fetal movement, during a 10-20-minute observation.
  • Assessment of the amount of amniotic fluid. With a sufficient amount of amniotic fluid, a column of amniotic fluid (a section of amniotic fluid free from parts of the fetus and umbilical cord) of at least 2 cm should be visualized in two mutually perpendicular sections in most of the uterine cavity.

Hypoxia. With an increase in hypoxemia, progressive inhibition of the biophysical functions of the fetus begins. Changes in some indicators (respiratory movements, motor activity of tone and reactivity) occur immediately after an episode of asphyxia, and changes in other parameters, for example, the amount of amniotic fluid, take longer; such parameters change during chronic hypoxia.

1. Acute hypoxia

  • Fetal respiratory movements stop first
  • Then the stress-free test becomes unreactive
  • The third change is the disappearance of fetal motor activity
  • Lastly, the fetal tone disappears.

2. In chronic hypoxia, the volume of amniotic fluid decreases within a few days or weeks.

Why is it important to do a biophysical profile of the fetus?

The fetal biophysical profile is used in some clinics as the primary antenatal test, while in others it is used only when the contraction stress test is positive or inconclusive. For example, the biophysical profile of the fetus is determined in the case of premature rupture of amniotic fluid. With the development of chorioamnionitis, complicating premature rupture of the membranes, the biophysical profile of the fetus is rarely satisfactory. In addition, with chorioamnionitis, the reactivity of the stress-free test disappears.

The maturation of the nervous system leads to the formation of a clear change in the periods of sleep and wakefulness in the fetus, which become distinguishable by the 20th week of pregnancy. After this period, the gynecologist may send the woman to study the biophysical profile of the fetus. In what cases is this test carried out and how to decipher it?

What is the biophysical profile of a fetus?

The biophysical profile of the fetus (BPP) is a summary assessment of the CTG study and ultrasound monitoring of the prenatal state of the child.

Ultrasound examination is carried out in real time. During the ultrasound, the amount of amniotic fluid and various types of movements of the baby are assessed.

The CTG method registers the variability of the fetal heart rate. Decoding from a cardiologist.

Indications for research

Determination of the biophysical profile of the fetus is carried out in the third trimester of pregnancy. It is prescribed to women with post-term pregnancy, as well as in the later stages, if there are the following indications:

  • intrauterine growth retardation according to ultrasound data;
  • diabetes mellitus, gestational diabetes, arterial hypertension and other chronic diseases that affect the course of pregnancy;
  • oligohydramnios or polyhydramnios;
  • reduced activity of the child;
  • delayed pregnancy;
  • the presence of a history of miscarriages in the later stages of unclear etiology.

Determination of the biophysical profile of the fetus

By week 28, the system of reactions to external influences is fully formed in the fetus. From this time on, the biophysical profile, also called the fetal well-being test, becomes informative.

Determination of BPP takes at least 40 minutes. During this time, the pregnant woman undergoes cardiotocography and ultrasound. To stimulate the child a little, you need to eat before the procedure.

PPP requires the results of a non-stress test. The norm is the acceleration of the number of heart beats after the child's own movements. If there are signs of depression of cardiac activity, then the heart rate will remain unchanged or, on the contrary, will slow down. To conduct CTG, a sensor is used that determines the tone of the uterus. It is placed on the abdomen above the navel, shifted to the right corner of the uterus.

The second sensor is placed in the projection of the back of the fetus, it registers the heart rate. A woman is given a special button in her hand, which she presses when a movement occurs. The duration of the recording is 20 minutes.

The fetal heart rate is extremely important:

  • The work of the kidneys depends on the heart rate. A decrease in urine output leads to a decrease in the amount of amniotic fluid.
  • The heart rate may indicate oxygen starvation, which, under various pathological conditions, leads to acidosis, which depresses the nervous system and cardiac activity.

Ultrasound is performed continuously for 30 minutes. If all indicators are recorded as normal, then the time is reduced. During an ultrasound, the doctor evaluates:

  • Respiratory movements of the chest - they are fickle, appear and disappear spontaneously. The episode is the moment from the beginning to the end of the respiratory movements. Normally, it is at least 60 seconds in half an hour.
  • Flexion or extensor movements of the trunk or limbs - they assess the tone. If the neck, arms, or legs are in an extended position, this is considered abnormal and may indicate serious problems, including antenatal death.
  • Motor activity, that is, any movement, displacement, rotation of the torso, arms or legs. Their total number during the study is calculated.
  • The volume of amniotic fluid - it reflects the metabolic state of the fetus.
  • The degree of maturity of the placenta - indicates the possible causes of hypoxia.

BPP decoding

The severity of each indicator is estimated in points from 0 to 2. The norm of the biophysical profile of the fetus indicates no risk.

Non-stress test:

  • 2 points if there were 5 episodes of heart rate acceleration in response to movement lasting from 15 seconds. with a force of at least 15 strokes;
  • 1 point is given for 2-4 such episodes;
  • episode - 0 points.

Breathing movements:

  • receive the maximum score if there were 1 or more episodes, lasting from 60 seconds;
  • periods of 30-60 sec. receive 1 point;
  • absence or breathing for less than 30 seconds. - 0 points.

Motor movements:

  • 3 or more motor movements are 2 points;
  • for 1-2 movements put 1 point;
  • 0 for no movement.

Flexion or extension movements:

  • Muscle tone is considered normal, in which at least one episode of limb and back flexion-extension is recorded, 2 points are given for it.
  • The score is given in the presence of one of the listed episodes.
  • Persistent extension, open palms is 0 points.

amniotic fluid:

  • should be in all pockets, depth from 2 cm;
  • pockets 1-2 cm are valued at 1 point;
  • less than 1 cm - 0 points.

The degree of maturity of the placenta:

  • 2 points are set for 0, 1, 2 degrees of placental maturity;
  • if its visualization is difficult, put 1 point;
  • the aging placenta of the 4th degree is estimated at 0 points.

The scores obtained are summarized:

  • The maximum possible amount is 12 points. The biophysical profile of the fetus 8 and 9 points is also considered the norm.
  • A score of 6-7 is considered doubtful. It requires additional observation and examination. A woman may be offered hospitalization in the pregnancy pathology department at the maternity hospital.
  • 5 or less points indicate a deep suffering of the fetus, which can lead to his death.

In the latter case, after the ultrasound room, the woman is urgently sent for hospitalization by her obstetrician-gynecologist. In a difficult situation, early delivery by caesarean section is performed to save the life of the child.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

Ultrasonic devices , working in real time, allow not only to assess the anatomical features of the fetus, but also to obtain sufficiently complete information about its functional state. At present, the so-called biophysical profile of the fetus(BFPP). Most authors include 6 parameters in this concept: non-stress test (NST) at cardiotocography and 5 indicators determined by ultrasound scanning in real time; fetal breathing movements (DDP); physical activity (YES); tone (T) fetus; volume of amniotic fluid (ALE); maturity of the placenta (FFP). The maximum score is 12 points. The high sensitivity and specificity of BFPP are explained by a combination of markers of acute (NST, DD, DA, and fetal T) and chronic (AOV, FFP) fetal disorders (Table). Reactive NST, even without additional data, is an indicator of a satisfactory condition of the fetus, while in the presence of non-reactive NST, it is of particular importance ultrasonography other biophysical parameters of the fetus.


table: Criteria for assessing biophysical parameters

The sum of points 12-8 indicates the normal condition of the fetus. BFPP assessment 7-6 points indicates a doubtful condition of the fetus and the possibility of developing complications. A score of 5-4 or less indicates the presence severe intrauterine fetal hypoxia and high risk of developing perinatal complications.

The definition of BFPP for obtaining objective information is possible already from the beginning of the III trimester of pregnancy.

Is the information incomplete? Try search from google .

The Fetal Biophysical Profile, or FBP for short, is a measure of the health of the fetus through ultrasound and heart rate monitoring—that is, non-stress tests. BPP allows you to assess the general health of the child: heartbeat, muscle tone, respiration, and the amount of amniotic fluid.

BPP is usually done in the last trimester of pregnancy.

2. Why do BPP?

The biophysical profile of the fetus is done:

  • To find out the general health of the child. Ultrasound during pregnancy shows the heartbeat, muscle tone, the baby's breathing, the amount of amniotic fluid;
  • To check the health of the child, if the mother has problems such as lupus, hyperthyroidism, chronic kidney disease, late pregnancy toxicosis, high blood pressure, oligohydramnios / polyhydramnios, type 1 diabetes and others;
  • If the mother is pregnant with twins or more.

3. How to prepare and how is BPP conducted?

How to prepare for BPP?

Before making a biophysical profile of the fetus, it is necessary to fill the bladder. If you smoke, then two hours before the test you need not to smoke.

How is BPP carried out?

Ultrasound during pregnancy is performed by a gynecologist, obstetrician or radiologist.

You will not need to take off your clothes for the ultrasound, it is enough to expose your stomach. If your bladder is not full enough, you may be asked to drink water. During the ultrasound, you will lie on your back on a special table. For ultrasound, a special gel is applied to the skin.

The test lasts about 30 minutes.

4. Risks and what can prevent PPP?

What are the risks of STD?

There are no risks of ultrasound during pregnancy.

What can interfere with BPP?

The biophysical profile of the fetus may not be informative if:

  • The fetus is in an uncomfortable position;
  • The mother is unable to keep a calm position;
  • The mother is obese;
  • There is an infection in the fetus or mother;
  • There is hypoglycemia or hyperglycemia;
  • You are taking medications such as magnesium sulfate;
  • The woman is abusing alcohol or drugs;
  • Rarely, stool or air in the intestines can interfere with the ultrasound.

What is worth knowing?

Biophysical profile of the fetus - general examination. After it, additional procedures may be needed. In some cases, on the recommendation of a doctor, BPP is performed several times.

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