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Biophysical Profile Score (BPS or BPP)

The biophysical profile score is a method used to asses the well being of a fetus at increased risk for death or damage in utero. The biophysical profile score evaluates the fetus for the presence of five biophysical parameters using ultrasound and an electronic fetal heart rate monitor. A score of 2 points is given for each parameter that meets criteria. The test is continued until all criteria are met or 30 minutes have elapsed. The points are then added for a maximum score of 10.
Component  Normal (2 points) Abnormal (0 points)
Fetal Breathing Movements One or more episodes of fetal breathing lasting at least 30 seconds within 30 minutes. No episodes of fetal breathing movements lasting at least 30 seconds during a 30 minute period of observation.
Gross Body Movement 3 or more discrete body or limb movements within 30 minutes Less than 3 body or limb movements in 30 minutes
Fetal Tone One or more episodes of active extension and flexion of a fetal extremity OR opening and closing of the hand within 30 minutes Slow extension with no return or slow return to flexion of a fetal extremity  OR no  fetal movement
Amniotic Fluid Volume * A single deepest vertical pocket of amniotic fluid measures greater than 2 centimeters. is present A single deepest vertical pocket of amniotic fluid measures 2 centimeters or less
Non-stress test (NST)** Reactive Nonreactive

*Amniotic Fluid Volume Measured as the vertical measurement , in centimeters, of the single deepest pocket of amniotic fluid with a transverse measurement of 1 cm or more wide  without fetal small parts or umbilical cord . [2]
** Reactive =
Two or more fetal heart rate accelerations that peak (but do not necessarily remain) at least 15 beats per minute above the baseline and last at least 15 seconds from baseline to baseline during  20 minutes of observation
Nonreactive = Less than two accelerations of fetal heart rate as described above after 40 minutes of observation [1]

A total  score of 8 or 10 is normal, a score of 6 is considered equivocal, and a score of 4 or less is abnormal   [1,3,6].


The Modified Biophysical Profile

Some testing centers use a modified BPP [4,5]. The modified BPP consists of the nonstress test (NST) and an amniotic fluid volume assessment. The modified BPP is considered normal if the NST is reactive and the deepest vertical pocket of amniotic fluid is  greater than 2 centimeters. The modified BPP is considered abnormal if either the NST is nonreactive or the deepest vertical pocket of amniotic fluid is 2 cm or less [1].

1. Antepartum fetal surveillance. Practice Bulletin No. 145. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:18292PMID:24945455
2. Chamberlain PF, Manning FA, Morrison I, Harman CR, Lange IR. Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volume to perinatal outcome. Am J Obstet Gynecol 1984;150:2459.PMID:6385713
3. Manning FA, et. al., Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high-risk pregnancies. I. Perinatal mortality by frequency and etiology.Am J Obstet Gynecol. 1985 Feb 1;151(3):343-50. PMID: 3881967
4. Nageotte MP, et. al. Perinatal outcome with the modified biophysical profile. Am J Obstet Gynecol. 1994 Jun;170(6):1672-6.
5.Miller DA, et. al., The modified biophysical profile: antepartum testing in the 1990s.Am J Obstet Gynecol. 1996 Mar;174(3):812-7. PMID:8633648
6. Fetal health surveillance: antepartum and intrapartum consensus guideline. Liston R, Sawchuck D, Young D; Society of Obstetrics and Gynaecologists of Canada; British Columbia Perinatal Health Program. J Obstet Gynaecol Can. 2007 Sep;29(9 Suppl 4):S3-56. Erratum in: J Obstet Gynaecol Can. 2007 Nov;29(11):909. PMID:17845745

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