Motor activity of the fetus 2 points. Biophysical profile of the fetus: what is it and how to study it? How is BPP performed?

05.03.2020

Real-time ultrasound devices allow not only to assess the anatomical features of the fetus, but also to obtain fairly complete information about its functional state. Currently, the so-called biophysical profile of the fetus (BFPP) has received wide use in assessing the intrauterine state of the fetus. Most authors include 6 parameters in this concept: non-stress test (NST) during cardiotocography and 5 indicators determined during real-time ultrasound scanning; fetal respiratory movements (FDP); motor activity (YES); tone (T) of the fetus; the volume of amniotic fluid (OOV); the degree of 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 T of the fetus) and chronic (AOV, FFP) fetal disorders (Table 4.5). Reactive NST, even without additional data, is an indicator of a satisfactory condition of the fetus, while in the presence of non-reactive NST, ultrasound examination of other biophysical parameters of the fetus is of particular importance.

Table 4.5.

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

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

When is it appointed?

A biophysical profile is usually performed in the last trimester of pregnancy.
It is also prescribed for pregnancy with various complications, such as hyperthyroidism, problems with the circulatory system, gestational or type 1 diabetes, chronic renal failure, hypertension, polyhydramnios or oligohydramnios, preeclampsia (history of stillbirth), Rhesus conflict, placental insufficiency or premature birth in history.
BFP may be prescribed for multiple pregnancies (twins or triplets), if the baby is too small, for a post-term pregnancy, and for trauma, such as a fall or car accident.
BFP is usually given between 32 and 34 weeks, you may need to do it every week.

How is it carried out?

BFP is usually performed by a radiologist, ultrasound specialist, or obstetrician in a hospital or medical center. Most doctors recommend doing a modified biophysical profile, along with an amniotic fluid test and a stress-free test.

stress free test

During this study, the baby's heartbeat is reflected on the monitor using an external device - two flat sensors - mounted on your abdomen. The sensors are connected to a machine that measures and records the duration and rate of heartbeats. The test takes about 30 minutes.

fetal ultrasound

You will need to come with a full bladder for the ultrasound. A gel will be applied to your abdomen. The transmitter, a small hand-held instrument that helps transmit images of the fetus to a monitor, is driven across the abdomen. The data obtained are reviewed by a doctor or radiologist, based on which the physical condition of the fetus is determined. The procedure can take up to an hour.

Test results

You will receive a result that determines the condition of your child in the five above-mentioned parameters. If the test result is 8-10 points, this means that the child is healthy. At 6-8 points, you will need to take another test within 12-24 hours. If the test scores are less than 4, then some problems are possible.

Video

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 not able 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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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

Currently, the so-called biophysical profile of the fetus is used to assess the intrauterine state of the fetus. Determination of the biophysical profile of the fetus to obtain objective information is possible already from the beginning of the third trimester of pregnancy.

The concept of "biophysical profile of the fetus" includes data from a non-stress test (with CTG) and indicators determined by ultrasound scanning: fetal respiratory movements, motor activity, fetal tone, volume of OB, degree of placental maturity. Each parameter is evaluated in points from 0 (pathology) to 2 (normal).

The scores are summed up and an indicator of the condition of the fetus is obtained (Table 11-6).

Table 11-6. Criteria for assessing the biophysical profile of the fetus (A. Vintzileos, 1983)

Options	Score
Options	2	1	0
Non-stress test	5 or more accelerations with an increase in the fetal heart rate of at least 15 beats and a duration of at least 15 s, associated with fetal movements, in 20 minutes	From 2 to 4 accelerations with an increase in the fetal heart rate of at least 15 beats and a duration of at least 15 s, associated with fetal movements, in 20 minutes	1 or less accelerations in 20 minutes
Fetal activity	At least 3 generalized movements within 30 minutes	1 or 2 generalized fetal movements within 30 minutes	Absence of generalized fetal movements within 30 minutes
Fetal respiratory movements	At least 1 episode of fetal respiratory movements lasting at least 60 seconds in 30 minutes	At least 1 episode of fetal respiratory movements lasting from 30 to 60 seconds in 30 minutes	Absence of fetal breathing or less than 30 seconds in 30 minutes
Fetal muscle tone	1 or more episodes of fetal limbs returning from extended to flexed position	At least 1 episode of return of fetal limbs from extended to flexed position	Limbs in extended position
Volume of organic matter	Vertical pocket of free water area 2–8 cm	2 or more pockets of OM 1–2 cm in size	RH pocket less than 1cm
The degree of maturity of the placenta	Corresponds to gestational age	-	III degree of maturity up to 37 weeks

The sum of points 8-12 indicates the normal condition of the fetus. An assessment of the biophysical profile of the fetus of 6–7 points indicates a dubious state of the fetus. A score of 4–5 or less is an indicator of severe fetal hypoxia and a high risk of perinatal complications.

High sensitivity and specificity of the biophysical profile of the fetus are explained by a combination of markers of acute (non-stress test, respiratory movements, motor activity and fetal tone) and chronic (volume of OB, degree of maturity of the placenta) disorders of the fetus. A reactive non-stress test, even without additional data, is an indicator of a satisfactory condition of the fetus, while in the presence of a non-reactive non-stress test, ultrasound of other biophysical parameters of the fetus is of particular importance.

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