“BIOPHYSICAL PROFILE”

2. “BIOPHYSICAL PROFILE” DrSeyedAsadollahKalantari OB & Gynecologist Isfahan Fertility & Infertility Center

3. BIOPHYSICAL PROFILE (BPP) • A noninvasive assessment of the fetus and its environment by U/S, noting normal and abnormal biophysical responses to stimuli. • A normal BPP indicates that the CNS is functional and the fetus is not hypoxemic. • A scoring system, of 5 variables, with a total score up to 10.

4. parameters Non-Stress Test Ultrasound

5. Biophysical profile • Probability of BPP score being at least 8/10 exceeds 97% • NST probability 85% • Rate of fetal death within 1 week of normal result 0.4-0.6/1,000 live births • False positive result depends on score • 6/10 75% FPR • 0/10: almost always indicative of fetal compromise • Broad range of predictive accuracy

6. How frequently? • Interval should be driven by the requirements for the test • Should be no more than 7 days • Maybe daily in some critical/unstable situations • Severe preeclampsia • Reduction in IUFD with twice-weekly testing • 6.1/1.000 to 1.9/1,000

7. Maternal and Fetal Indications • APLS • Hyperthyroidism • Hemoglobinopathies • Cyanotic heart disease • SLE • Chronic renal disease • DM 1 and 2 • Hypertensive disorders • Decreased fetal movement • Oligo/polyhydramnios • IUGR • Postterm pregnancy • Isoimmunization • Moderate to severe • Previous fetal demise • Unexplained or recurrent risk • Multiple gestation with growth discordancy

8. PATHOPHYSIOLOGIC BASIS OF THE BIOPHYSICAL PROFILE • Hypoxemia and acidemia have interference with central nervous system (CNS) • oligohydramnios with fetal hypoxemia as a result of blood flow redistributed away from the fetal kidneys and viscera in favor of the brain, heart, and adrenal glands. • When activities of these oxygen-dependent centers are observed, it can be assumed that brain function is normal and systemic hypoxia is not present • if one or more of the BPP activities is not observed, hypoxemia must be assumed to be the cause of the absence of that activity.

9. Biophysical Profile Variables • Fetal breathing movements • Gross body movement • Fetal tone • Amniotic fluid volume index • Non-stress test

10. Basic Physiology & PathoPhysiology ofBIOPHYSICAL PROFILE • Acute Marker Fetal breathing movements Gross body movement Fetal tone Non-stress test • Chronic Marker Amniotic fluid volume index Placental grading

11. Maturation of Central Nervous System Regulatory Centers

12. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal

14. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal

15. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal

16. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal

17. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal

24. Recommended Fetal Treatment According to the Biophysical Profile

25. Recommended Fetal Treatment According to the Biophysical Profile Score

26. Recommended Fetal Treatment According to the Biophysical Profile Score

31. Fetal Central Nervous System Center Embriogenesis Hypoxia

33. Using This Score, The following Outcomes have been reported: • Weighted Score 10 - Adverse Fetal Outcome 0% • Weighted Score 8 - Adverse Fetal Outcome 0% • Weighted Score 6 - Adverse Fetal Outcome 1% • Weighted Score 4 - Adverse Fetal Outcome 22% • Weighted Score 2 - Adverse Fetal Outcome 77%

38. Factors Affecting the Biophysical Profile

39. Factors Affecting the Biophysical Profile

40. THANK YOU