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Biophysical Profile (BPP) Protocol Reference page 603 in pocket protocol book This is a timed examination the maximum length of time is 30 minutes An acoustic stimulator may be used to encourage fetal movement, however it should only be used during the last 10 minutes of the examination and used sparingly This protocol has 2 sonographic components: Structure documentation and BPP Parameters Fetal Structure Documentation Structure Scan Plane Label Landmarks Identified TX NO IMAGESCAN THROUGH TX HEART RATE TX HEART RATE Sagittal CERVIX ML Sagittal CERVIX ML Sagittal FETAL LIE PLACENTA SAG INF PLACENTA SAG MID PLACENTA SAG SUP Uterus/Fetus Uterus Sagittal Placenta Sagittal Sagittal Umbilical Artery Cord Color Doppler and Spectral Analysis Long Axis CORD Begin at cervix, move superiorly out of uterine fundus o Identify the fetus within the uterus o Identify number of fetuses o Identify fetal lie o Determine the right and left sides of the fetus Fetal heart and chest o Enlarge image of heart and document heart rate with M-mode or Spectral Doppler Fetal heart and chest o Enlarge image of heart and document heart rate with a cine-loop Vaginal Canal Cervix Amniotic Sac Vaginal Canal Cervix Amniotic Sac Measure Cervical Length o External os to internal os Document presenting fetal structure Cervix o Indicate Breech or Vertex in annotation Placenta closest to Cervix Retroplacental complex Placenta Mid- include cord insertion Retroplacental complex Placenta- superior portion Retroplacental complex Free floating loop of cord o Document Color Doppler and spectral analysis of the umbilical artery HMP:\Protocols\OBGYN Protocols\OB Biophysical Profile Protocol .docx Biophysical Profile (BPP) Documentation for Biophysical Profile Parameters Structure Scan Plane Variable Label MOVEMENT Landmarks Identified Variable Biophysical Profile Test TONE Fetal Long Axis BREATHING 4-Sagittal Images Q1 Q1+Q2+Q3+Q4= AFI Q2 Q3 Structures seen in each pocket will vary Q4 Fetal Trunk Measurement criteria o Fetus must perform 3 separate gross body movements Fetal Extremity Measurement criteria o Fetus must perform 1 quick flexion/extension of an extremity or spine Fetal Diaphragm (RT or Left) Measurement criteria o Fetus must perform 30 continuous seconds of practice breathing Measure largest vertical pocket clear of fetal components from Anterior to Posterior Measure largest vertical pocket clear of fetal components from Anterior to Posterior Measure largest vertical pocket clear of fetal components from Anterior to Posterior Measure largest vertical pocket clear of fetal components from Anterior to Posterior Understanding the Components of the Test Each component of the BPP Test meeting criteria receives 2 points, if criteria is not met 0 points are given This may be done alone or in combination with complete exams or fetal growth exams The components of the test are more important than the overall score Components not present can indicate fetal distress and/or fetal asphyxia In cases of distress and/or asphyxia the components will begin to disappear in the following order: 1. Breathing movements 2. Movement 3. Tone If a component is not seen it does not necessarily mean that the fetus is in distress however follow-up BPP’S are used to determine the gradual onset of distress If all components are missing or if the total score is 2 or less, delivery of the baby is highly considered Utilizing Spectral Analysis in combination with BPP is a good indicator of fetal condition Medications given to mother may alter results of the BPP. Some medications include Corticosteriods –drug used to stimulate lung maturity in the fetus Magnesium Sulfate-drug used to stop or slow down pre-mature contractions HMP:\Protocols\OBGYN Protocols\OB Biophysical Profile Protocol .docx Biophysical Profile (BPP) Color and Spectral Doppler Analysis Structure Area of Interest Plane Umbilical Artery Document umbilical artery blood flow with Color Doppler and Spectral Analysis in a free loop of the umbilical cord Longitudinal Document umbilical artery blood flow with Color Doppler and Spectral Analysis in a free loop of the umbilical cord Lateral branches of the circle of Willis Longitudinal Umbilical Vein Middle Cerebral Artery Normal Measurement S/D= less than 3 after 30 week PI= less than 1.25 after 30 week Coronal RI-less than .7 after 30 weeks 2nd-3rd trimester= Continuous forward flow with increasing mean velocities until 37 weeks PI= Greater than 1.45 before term Less than 1 by term (Decreases after 32 weeks) Ductus Venosus Shunt between the umbilical vein and inferior vena cava Transverse Abdomen Peak velocity= 50 cm/sec HMP:\Protocols\OBGYN Protocols\OB Biophysical Profile Protocol .docx Comments Angle correct is not needed Low resistive wave form High end diastolic flow is normal Absence of diastolic flow indicates fetus is in distress Reversal of diastolic flow is severe and seek immediate help from physician Pulsations can indicate a severe condition Fetal breathing movements will alter continuous forward flow pattern Found slightly caudal to BPD plane Same proximal end Position the head to achieve a Doppler angle of zero or as close as possible High impedance flow with low diastolic flow Abnormal flow will display high diastolic flow Indicate pre-eclampsia, IUGR & anemia High diastolic component Evaluate the “A” wave-abnormal if less than 5cm/sec