Modified BPP consists of:
Ans. a. NST with amniotic fluid index (Ref: Williams Obstetrics 24/e p342. 343)Modified Biophysical profile consists of NST with amniotic fluid index.Modified Biophysical Profile: Because the biophysical profile is labor intensive and requires a person trained in sonography, Clark and coworkers (1989) used an abbreviated biophysical profile as a first-line screening test in 2628 singleton pregnancies. Specifically, a vibroacoustic nonstress test was performed twice weekly and combined with amnionic fluid index determination for which < 5 cm was considered abnormal. This abbreviated biophysical profile required approximately 10 minutes to perform, and they concluded that it was a superb antepartum surveillance method because there were no unexpected fetal deaths. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics (2012) have concluded that the modified biophysical profile test is as predictive of fetal well-being as other approaches to biophysical fetal surveillance. ''-- Williams Obstetrics 24/e 343Biophysical ProfileManning proposed combined use of 5 fetal biophysical variables as a more accurate means of assessing fetal health than a single elementQ.Typically, these tests require 30 to 60 minutes of examiner tuneQ.5 fetal biophysical components assessed: (1) heart rate acceleration, (2) breathing, (3) movements, (4) tone, and (5) amniotic fluid volumeQ.Normal variables were assigned a score of 2 each, and abnormal variables were given a score of 0Q.Highest score possible for a normal fetus is 10Q.Components and Scores for the Biophysical ProfileComponentScore 2Score 0Non stresstest> 2 acceleration of > 15 beats/min for > 15 sec within 20-40 min0 or 1 acceleration within 20- 40 minutesFetal breathing> 1 episode of rhythmic breathing lasting > 30 sec within 30 min< 30 sec of breathing within 30Fetal movement> 3 discrete body or limb movements within 30 min< 3 discrete movementsFetal tone> 1 episode of extremity extension and subsequent return to flexion0 exiension/flextion eventsAmniotic fluid volumeA pocket of amniotic fluid that measure at least 2 cm in two planes perpendicular to each other (2 x 2 cm pocket)Largest single vertical pocket < 2 Interpretation of Biophysical Profile ScoreBiophysical profile ScoreInterpretationRecommended Management10Normal, non-asphyxiated fetus* No fetal indication for intervention, repeat test weekly except in diabetic patients & Post-term pregnancy (twice weekly)8/10 (Normal AFV) 8/8 (NST not done)Normal, non-asphyxiated fetus* No fetal indication for intervention; repeat testing as per protocol8/10 (Decreased AFV)Chronic fetal asphyxiasuspected* Deliver6Possible fetal asphyxia* If amniotic fluid volume abnormal, deliver* If normal fluid at > 36 weeks with favourable Cervix, deliver* If repeat test > 6, deliver* If repeat test > 6, observe, and repeat as per protocol4Probable fetal asphyxia* Repeat testing same day; if biophysical profile score < 6, deliver0 to 2Almost certain fetal asphyxia* Deliver
NST with AFI
NST with fetal breathing
NST with fetal movement
NST with fetal tone
Fetal Assessment