Download Biophysical Profile (BPP) Protocol Reference page 603 in pocket

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
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TX
NO IMAGESCAN
THROUGH
TX
HEART RATE
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TX
HEART RATE
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Sagittal
CERVIX ML
Sagittal
CERVIX ML
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Sagittal
FETAL LIE
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PLACENTA
SAG INF
PLACENTA
SAG MID
PLACENTA
SAG SUP
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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
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Variable
Biophysical
Profile Test
TONE
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Fetal Long Axis
BREATHING
4-Sagittal Images
Q1
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Q1+Q2+Q3+Q4=
AFI
Q2
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Q3
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Structures seen in
each pocket will
vary
Q4
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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
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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
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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
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Pulsations can indicate a severe condition
Fetal breathing movements will alter
continuous forward flow pattern
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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
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Indicate pre-eclampsia, IUGR & anemia
High diastolic component
Evaluate the “A” wave-abnormal if less than
5cm/sec