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** 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 
Biophysical Profile Test Score Results
A total score of 10 out of 10 or 8 out of 10 with normal fluid is considered normal. A score of 6 is considered equivocal, and a score of 4 or less is abnormal [1,3, 6]. A score of less than 8 indicates the fetus may not be receiving enough oxygen. However, decreased biophysical activities may also be seen for a brief time in the preterm fetus after treatment with ether betamethasone or dexamethasone given to enhance fetal lung maturity . The likelihood that the fetus is not getting enough oxygen and the risk for fetal death increase as the BPP score decreases.
The Modified Biophysical Profile (MBPP)
Some testing centers use a modified biophysical
profile [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 .
When is the MBPP or BPP Usually Performed?
The modified BPP may be performed for decreased fetal movement. If the NST is nonreactive or the amniotic fluid volume is low a full BPP is usually done.
ACOG recommends the MBPP or BPP may also be used for antepartum fetal surveillance in pregnancies at increased risk for bad perinatal outcomes including , but not limited to, pregnancies complicated by hypertension, preeclampsia, pregestational diabetes, poorly controlled or medically treated gestational diabetes, poorly controlled hyperthyroidism, chronic renal disease, systemic lupus erythematosus, antiphospholipid syndrome, hemoglobinopathy (sickle cell disease) , maternal cyanotic heart disease, moderate or severe asthma during pregnancy, isoimmunization, oligohydramnios, unexplained or recurrent risk for stillbirth, fetal growth restriction , and late term pregnancy at or beyond 41 0/7 weeks [1, 9,10].
The Society of Obstetricians and Gynaecologists of Canada (SOGC) suggests antenatal fetal surveillance may also be beneficial in pregnancies complicated by preterm premature rupture of membranes, chronic (stable abruption) , vaginal bleeding, abnormal maternal serum screening in the absence of confirmed fetal anomaly, motor vehicle accident during pregnancy, morbid obesity, advanced maternal age, assisted reproductive technologies , multiple pregnancy, polyhydramnios, and preterm labor .
In addition to many of the above indications an executive summary by a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop on antenatal testing suggested antepartum testing for cholestasis of pregnancy was appropriate. However, the workshop found insufficient data to recommend antenatal testing for other conditions such as obesity, advanced maternal age, abnormal maternal serum markers, thrombophilias, triplets and higher-order multiples .
The American College of Obstetricians and Gynecologists has observed that despite a lack of high quality evidence that antepartum surveillance decreases the risk of fetal death ..."antepartum fetal surveillance is widely integrated into clinical practice in the developed world." [1,8]. ACOG advises "... initiating antepartum fetal testing no earlier than 32 0/7 weeks of gestation is appropriate for most at-risk patients . However, in pregnancies with multiple or particularly worrisome high-risk conditions (e.g., chronic hypertension with suspected fetal growth restriction), testing might begin at a gestational age when delivery would be considered for perinatal benefit". If delivery is not planned (eg, given early gestational age), then antenatal surveillance should not be performed because the results will not inform management .
Reviewed by Mark Curran, M.D.
1. Antepartum fetal surveillance.
Practice Bulletin No. 145. American College of Obstetricians and Gynecologists.
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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. PMID:8203424
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 Available at: http://sogc.org/wp-content/uploads/2013/01/gui197CPG0709r.pdf
7. Rotmensch S, et. al., The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial.Acta Obstet Gynecol Scand. 1999 Jul;78(6):493-500. PMID: PMID:10376858
8.Lalor JG, et. al. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000038. doi: 10.1002/14651858.CD000038.pub2. PMID: PMID:18253968
9. Asthma in pregnancy. ACOG Practice Bulletin No. 90. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008; 111:457–64.PMID: PMID:18238988
10. Management of late-term and postterm pregnancies. Practice Bulletin No. 146. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:390–6.PMID: PMID:25050770
11. Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol. 2009;113:687–701 PMID: PMID:19300336