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
• Begin at cervix, move superiorly out of uterine
fundus
NO IMAGE- o Identify the fetus within the uterus
TX SCAN o Identify number of fetuses

THROUGH o Identify fetal lie
o Determine the right and left sides of the
Uterus/Fetus fetus
TX HEART RATE • Fetal heart and chest
o Enlarge image of heart and document heart
rate with M-mode or Spectral Doppler
TX HEART RATE • Fetal heart and chest
o Enlarge image of heart and document heart

rate with a cine-loop
Sagittal CERVIX ML • Vaginal Canal
• Cervix

• Amniotic Sac
Sagittal CERVIX ML • Vaginal Canal
• Cervix

Uterus • Amniotic Sac
• Measure Cervical Length
o External os to internal os
Sagittal FETAL LIE • Document presenting fetal structure
• Cervix
o Indicate Breech or Vertex in annotation
PLACENTA • Placenta closest to Cervix
Sagittal
SAG INF • Retroplacental complex
PLACENTA • Placenta Mid- include cord insertion
Placenta Sagittal
SAG MID • Retroplacental complex
PLACENTA • Placenta- superior portion
Sagittal
SAG SUP • Retroplacental complex
Umbilical Artery • Free floating loop of cord
Cord o Document Color Doppler and spectral

Color Doppler Long Axis CORD analysis of the umbilical artery
and Spectral
Analysis

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 Biophysical Profile (BPP)


Documentation for Biophysical Profile Parameters

Structure Scan Plane Label Landmarks Identified
• Fetal Trunk
• Measurement criteria
Variable MOVEMENT
o Fetus must perform 3 separate gross
body movements
• Fetal Extremity
• Measurement criteria
Variable TONE o Fetus must perform 1 quick
flexion/extension of an extremity or
spine
Biophysical • Fetal Diaphragm (RT or Left)
Profile Test • Measurement criteria
Fetal Long Axis BREATHING
o Fetus must perform 30 continuous
seconds of practice breathing
4-Sagittal Images Q1 • Measure largest vertical pocket clear of fetal
components from Anterior to Posterior
Q1+Q2+Q3+Q4= Q2 • Measure largest vertical pocket clear of fetal
AFI components from Anterior to Posterior
Q3 • Measure largest vertical pocket clear of fetal
Structures seen in components from Anterior to Posterior
each pocket will • Measure largest vertical pocket clear of fetal
Q4
vary 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




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 Biophysical Profile (BPP)

Color and Spectral Doppler Analysis

Structure Area of Interest Plane Normal Comments

Measurement
Umbilical Document Longitudinal S/D= less than 3 • Angle correct is not needed
Artery umbilical artery after 30 week • Low resistive wave form
blood flow with • High end diastolic flow is normal
Color Doppler and PI= less than 1.25 • Absence of diastolic flow indicates fetus is
Spectral Analysis after 30 week in distress
in a free loop of • Reversal of diastolic flow is severe and seek
the umbilical cord RI-less than .7 after immediate help from physician
30 weeks
Umbilical Document Longitudinal 2nd-3rd trimester= • Pulsations can indicate a severe condition
Vein umbilical artery Continuous • Fetal breathing movements will alter
blood flow with forward flow with continuous forward flow pattern
Color Doppler and increasing mean
Spectral Analysis velocities until 37
in a free loop of weeks
the umbilical cord
Middle Lateral branches Coronal PI= • Found slightly caudal to BPD plane
Cerebral of the circle of • Same proximal end
Artery Willis Greater than 1.45 • Position the head to achieve a Doppler
before term angle of zero or as close as possible
• High impedance flow with low diastolic flow
Less than 1 by term • Abnormal flow will display high diastolic
(Decreases after 32 flow
weeks)

Ductus Shunt between Transverse Peak velocity= • Indicate pre-eclampsia, IUGR & anemia
Venosus the umbilical vein Abdomen 50 cm/sec • High diastolic component
and inferior vena • Evaluate the “A” wave-abnormal if less than
cava 5cm/sec

HMP:\Protocols\OBGYN Protocols\OB Biophysical Profile Protocol .docx