eMedicine Specialties > Radiology > Obstetrics/Gynecology
Biophysical Profile, Ultrasound
Updated: Oct 17, 2008
Introduction
The biophysical profile (BPP) is a noninvasive test that predicts the presence or absence of fetal asphyxia and, ultimately, the risk of fetal death in the antenatal period.1 When the BPP identifies a compromised fetus, measures can be taken to intervene before progressive metabolic acidosis leads to fetal death.2,3,4
The BPP combines data from 2 sources (ie, ultrasound imaging and fetal heart rate [FHR] monitoring). Dynamic realtime B-mode ultrasound is used to measure the amniotic fluid volume (AFV) and to observe several types of fetal movement. The FHR is obtained using a pulsed Doppler transducer integrated with a high-speed microprocessor, which provides a continuously updated reading.5
Originally described by Manning and colleagues,6,7 the BPP has become a standard tool for providing antepartum fetal surveillance. The BPP integrates 5 parameters to yield a biophysical profile score (BPS) and includes (1) the nonstress test (NST), (2) ultrasound measurement of the AFV, (3) observation of the presence or absence of fetal breathing movements, (4) gross body movements, and (5) tone. Table 1 (see below) describes specific criteria for the BPS.
The BPP allows 2 points for each parameter that is present, yielding a maximum score of 10; however, if all the ultrasound variable findings are normal, the FHR variable may be excluded because no change is made in the predicative accuracy of the BPP by including the FHR. If one or more ultrasound variable findings are abnormal, the NST should be performed.
A basic principle of antepartum testing is that a more accurate prediction of fetal wellness is achieved in direct proportion to the number of variables considered. The BPP is a clinical tool that integrates levels of dynamic biophysical activities into a usable standard.8 The BPP allows 2 points for each parameter that is present, yielding a maximum score of 10; however, if all ultrasound variables are normal, the FHR variable may be excluded because no change is made in the predictive accuracy of the BPP by including the FHR. If one or more ultrasound variables are abnormal, the NST should be performed.9
Table 1. Criteria for Coding Fetal Biophysical Variables as Normal or Abnormal
Open table in new window
Table
| Biophysical Variable | Normal (Score = 2) | Abnormal (Score = 0) |
|---|---|---|
| Fetal breathing movements | 1 or more episodes of >20 s within 30 min | Absent or no episode of >20 s within 30 min |
| Gross body movements | 2 or more discrete body/ limb movements within 30 min (episodes of active continuous movement considered as a single movement) | <2 episodes of body/limb movements within 30 min |
| Fetal tone | 1 or more episodes of active extension with return to flexion of fetal limb(s) or trunk (opening and closing of hand considered normal tone) | Slow extension with return to partial flexion, movement of limb in full extension, absent fetal movement, or partially open fetal hand |
| Reactive FHR | 2 or more episodes of acceleration of >15 bmp* and of >15 s associated with fetal movement within 20 min | 1 or more episodes of acceleration of fetal heart rate or acceleration of <15 bmp within 20 min |
| Qualitative AFV | 1 or more pockets of fluid measuring >2 cm in vertical axis | Either no pockets or largest pocket <2 cm in vertical axis |
| Biophysical Variable | Normal (Score = 2) | Abnormal (Score = 0) |
|---|---|---|
| Fetal breathing movements | 1 or more episodes of >20 s within 30 min | Absent or no episode of >20 s within 30 min |
| Gross body movements | 2 or more discrete body/ limb movements within 30 min (episodes of active continuous movement considered as a single movement) | <2 episodes of body/limb movements within 30 min |
| Fetal tone | 1 or more episodes of active extension with return to flexion of fetal limb(s) or trunk (opening and closing of hand considered normal tone) | Slow extension with return to partial flexion, movement of limb in full extension, absent fetal movement, or partially open fetal hand |
| Reactive FHR | 2 or more episodes of acceleration of >15 bmp* and of >15 s associated with fetal movement within 20 min | 1 or more episodes of acceleration of fetal heart rate or acceleration of <15 bmp within 20 min |
| Qualitative AFV | 1 or more pockets of fluid measuring >2 cm in vertical axis | Either no pockets or largest pocket <2 cm in vertical axis |
*Beats per minute
Reprinted with permission from Manning, 1999
Related eMedicine topics:
The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy - Pediatrics
Evaluation of Fetal Death - Obstetrics & Gynecology
Fetal Growth Restriction - Obstetrics & Gynecology
Related Medscape topics:
Radiology CME and News
Specialty Site Radiology
CME Impaired Fetal Growth, Low Birth Weight Linked to Poor Heart Health in Adulthood
CME Fetal Oximetry Plus Electronic Fetal Monitoring Does Not Reduce Cesarean Delivery Rates
Ultrasound Measurement of Fetal Growth Facilitates Management of Gestational Diabetes
Nonstress Test
The nonstress test (NST) is a noninvasive method used to evaluate fetal well-being. The NST is derived from observations that a fetus that is not acidotic and has an intact normally functioning autonomic nervous system will have periodic accelerations of the fetal heart rate (FHR). Acceleration is defined as a rise in the FHR-baseline rate that peaks at least 15 bmp above the baseline and lasts for at least 15 seconds from the beginning of the rise until the return to the FHR baseline.
Accelerations almost always occur with fetal movement. Partial umbilical cord compression with transient occlusion of the umbilical vein also can cause accelerations. This occurs with normal autonomic function, which acts to preserve cardiac output by increasing heart rate in response to decreased blood return to the fetal heart.
NSTs are described as either reactive or nonreactive. An NST is considered reactive if at least 2 accelerations are present in a 20-minute period. Occasionally, the NST may require 40 minutes or more of FHR recording to account for variations of the fetal sleep-wake cycle. An NST is considered nonreactive if sufficient accelerations are absent within a 40-minute period.
Decelerations of the FHR may be seen in as many as 50% of NSTs.10 If decelerations are nonrepetitive and less than 30 seconds in duration, obstetric intervention is not needed; however, repetitive decelerations or decelerations that last longer than 60 seconds are associated with an increased risk of fetal demise and cesarean delivery for the diagnosis of nonreassuring FHR pattern.11 Image 1 shows a reactive NST.
Pathophysiologic Basis of the Biophysical Profile
Hypoxemia and acidemia have been shown to interfere with measures of central nervous system (CNS) performance, such as fetal heart rate (FHR) patterns, fetal movement, and tone, in both animals and humans.12 Most likely, oligohydramnios results from decreased fetal urine production, which is seen 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.13
Each of the movements evaluated in the biophysical profile (BPP) results from efferent signals originating in different CNS centers, which mature at different gestational ages (see Table 2). When activities known to originate from each of these oxygen-dependent centers are observed, it can be assumed that brain function is normal and systemic hypoxia is not present. Conversely, if one or more of the BPP activities is not observed within the prescribed observation period of 30 minutes, hypoxemia must be assumed to be the cause of the absence of that activity.
Table 2. Maturation of Central Nervous System Regulatory Centers
Open table in new window
Table
| Activity | Gestational Age of Maturation (wk) |
|---|---|
| Gross body movements | 6 |
| Breathing movements | 12-14 |
| FHR accelerations resulting from fetal movement | 18-20 |
| Sleep-wake cycles | 18-22 |
| Integrated behavioral patterns | 28 |
| Activity | Gestational Age of Maturation (wk) |
|---|---|
| Gross body movements | 6 |
| Breathing movements | 12-14 |
| FHR accelerations resulting from fetal movement | 18-20 |
| Sleep-wake cycles | 18-22 |
| Integrated behavioral patterns | 28 |
However, the clinical reality is that hypoxemia is the least likely reason for the absence of a particular activity. In most fetuses, absence of a particular activity results from normal variations in fetal movements.14 Usually, this results from fetal sleep-wake cycles, which are approximately 20 minutes in length. The observation period of 30 minutes was chosen arbitrarily to exclude the effects of the fetal sleep-wake cycle on the majority of biophysical activities. Table 3 shows a variety of factors, other than hypoxemia, that have been shown to affect different BPP parameters.
Table 3. Factors Affecting the Biophysical Profile
Open table in new window
Table
| Activity | FHR Accelerations | Tone | Gross Movement | Fetal Breathing | AFV |
|---|---|---|---|---|---|
| Fetal sleep | ß | ß | ß | ß | |
| Early gestational age (<33 wk) | ß | ß | |||
| Late gestational age (>42 wk) | ß | ß | ß | ß | |
| Maternal glucose ingestion | — | — | Ý | ||
| Maternal alcohol ingestion | ß/— | Ý/— | |||
| Maternal magnesium administration | ß | ß | |||
| Artificial rupture of membranes | ß | ß | |||
| Premature rupture of membranes | ß | ||||
| Labor | ß |
| Activity | FHR Accelerations | Tone | Gross Movement | Fetal Breathing | AFV |
|---|---|---|---|---|---|
| Fetal sleep | ß | ß | ß | ß | |
| Early gestational age (<33 wk) | ß | ß | |||
| Late gestational age (>42 wk) | ß | ß | ß | ß | |
| Maternal glucose ingestion | — | — | Ý | ||
| Maternal alcohol ingestion | ß/— | Ý/— | |||
| Maternal magnesium administration | ß | ß | |||
| Artificial rupture of membranes | ß | ß | |||
| Premature rupture of membranes | ß | ||||
| Labor | ß |
Key: A blank box indicates that no data are available for that parameter.
Horizontal lines indicate that the parameter has been studied and that no change is demonstrated.
Arrows indicate that the parameter has been studied and that it increases or decreases as shown.
Biophysical Profile Procedure
The ultrasound portion of the biophysical profile (BPP) should begin by noting the starting time.2 The profile may be completed when all of the variables have been observed; however, a full 30 minutes must elapse before the profile is judged to be abnormal. The scan should start with a general survey, noting the position of the fetus and the presence of cardiac activity. Although not part of the BPP, surveying the placental position and grade and the fetal morphology is common practice during observation of fetal activity.
Amniotic fluid volume (AFV) is assessed as normal if one or more pockets of fluid are detected that measure at least 2 cm along the vertical axis. Oligohydramnios is present if the largest pocket measures less than 2 cm. The video in Image 6 shows 4 pockets of fluid being measured.
The pressure applied to the transducer by the sonographer is inversely proportional to the depth of the fluid pocket.15 Careful attention to transducer pressure is required to avoid a false diagnosis of oligohydramnios, which can result from excessive transducer pressure compressing the maternal abdomen.
Fetal movements are judged as normal or abnormal according to the criteria established in Table 1 (see Introduction). The video in Image 2 shows breathing movements, while the video in Image 3 shows movements that can be mistaken for fetal breathing. The videos in Image 4 and Image 5 demonstrate gross movements and tone. The video in Image 6 demonstrates the amniotic fluid index (AFI).
Amniotic Fluid Index
The amniotic fluid index (AFI) is a semiquantitative method for evaluating the amniotic fluid volume (AFV). The AFI is derived by adding the largest vertically measured fluid pocket from each uterine quadrant. This method appears to be at least as accurate as the largest–pocket-of-fluid method and can be reasonably substituted as an alternative method for evaluating AFV in the biophysical profile (BPP). Using this method, oligohydramnios is defined as an AFI of less than 5.
To obtain an AFI, the mother must be in the supine position and the linear ultrasound probe must be parallel to the maternal spine and perpendicular to the floor for all measurements. The abdomen is divided into 4 quadrants, with the umbilicus delineating the upper and lower halves and the linea nigra delineating the left and right halves.16 The largest pocket of fluid in each quadrant is measured along the vertical dimension, which is the dimension perpendicular to the ultrasound probe.17 The pockets must be free of umbilical cord or fetal extremities, although brief appearances of these are acceptable. The video in Image 6 demonstrates measurement of the AFI.
The Modified Biophysical Profile
A modified biophysical profile (BPP) consisting of a nonstress test (NST) and an amniotic fluid index (AFI) is used widely.18 If either the NST or the AFI is abnormal, a complete BPP or a contraction stress test (CST) is performed. The modified BPP, CST, and complete BPP have similarly low false-negative mortality rates, defined as the number of fetal deaths within 1 week of a normal test result.19 Nevertheless, no clear evidence exists that the 2 variables used in the modified BPP are better predictors than the other variables omitted from the BPP.20 Furthermore, this method requires 2 modalities for fetal evaluation, while normal ultrasound findings in a BPP eliminate the need for an NST.
Application of the Biophysical Profile
Antepartum testing using the biophysical profile (BPP) or any other method should not be performed earlier than the gestational age at which extrauterine survival or active intervention for fetal compromise is possible. Furthermore, no indications exist for testing in a fetus at term when likelihood of successful induction is high or when vaginal delivery is contraindicated for obstetric reasons. For patients with a low probability of successful induction, the BPP is a useful tool that can be used while waiting for cervical ripening. In these patients, the purpose of the BPP is to avoid the maternal morbidity resulting from failed induction followed by cesarean delivery.
The frequency of testing varies according to the clinical variables in each patient. In most high-risk pregnancies, testing plans start with weekly testing,3 although twice-weekly testing is the standard for pregnancies beyond 42 weeks and for patients with insulin-dependent diabetes.12 Frequency of testing increases in direct proportion to the severity of the maternal or fetal condition. In unstable pregnancies with progressive deterioration of the fetal condition, abnormal umbilical cord blood flow patterns occur first. Subsequently, fetal heart rate (FHR) variation is reduced, followed by loss of breathing movements, while general fetal movements and tone are the last parameters to demonstrate abnormal results. Frequent assessment of fetal BPP movements may help prolong the pregnancy in fetuses with a marginally reduced FHR variation.
An abnormal BPS should prompt further evaluation or intervention depending on the circumstances. If an abnormal score occurs in a term fetus, preparation should be made for delivery. An abnormal score in a fetus remote from term requires conservative management, since the risk of fetal death is similar to the neonatal mortality rate resulting from prematurity. In these patients, daily testing often is performed. Table 4 provides general guidelines for treatment following the BPS.
Table 4. Recommended Fetal Treatment According to the Biophysical Profile Score
Open table in new window
Table
| Result | Interpretation | Risk of Asphyxia* (%) | Risk of Fetal Death (per 1000/wk) | Recommended Treatment |
|---|---|---|---|---|
| 10/10 | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/10 (normal AFV) | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/8 (NST not performed) | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/10 (decreased AFV) | Chronic compensated asphyxia | 5-10 (estimate) | 20-30 |
|
| 6/10 (normal AFV) | Acute asphyxia possible | 0 | 50 |
|
| 6/10 (decreased AFV) | Chronic asphyxia with possible acute asphyxia | >10 | >50 |
|
| 4/10 (normal AFV) | Acute asphyxia likely | 36 | 115 |
|
| 4/10 (decreased AFV) | Chronic asphyxia with acute asphyxia likely | >36 | >115 | If ³ 26 wk, deliver |
| 2/10 (normal AFV) | Acute asphyxia almost certain | 73 | 220 | If ³ 26 wk, deliver |
| 0/10 | Gross severe asphyxia | 100 | 100 | If ³ 26 wk, deliver |
| Result | Interpretation | Risk of Asphyxia* (%) | Risk of Fetal Death (per 1000/wk) | Recommended Treatment |
|---|---|---|---|---|
| 10/10 | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/10 (normal AFV) | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/8 (NST not performed) | Nonasphyxiated | 0 | 0.565 | Conservative |
| 8/10 (decreased AFV) | Chronic compensated asphyxia | 5-10 (estimate) | 20-30 |
|
| 6/10 (normal AFV) | Acute asphyxia possible | 0 | 50 |
|
| 6/10 (decreased AFV) | Chronic asphyxia with possible acute asphyxia | >10 | >50 |
|
| 4/10 (normal AFV) | Acute asphyxia likely | 36 | 115 |
|
| 4/10 (decreased AFV) | Chronic asphyxia with acute asphyxia likely | >36 | >115 | If ³ 26 wk, deliver |
| 2/10 (normal AFV) | Acute asphyxia almost certain | 73 | 220 | If ³ 26 wk, deliver |
| 0/10 | Gross severe asphyxia | 100 | 100 | If ³ 26 wk, deliver |
*Umbilical venous blood pH less than 7.25
Reprinted with permission of Manning, 1999
Reliability of the Biophysical Profile
The biophysical profile (BPP) is a reliable method of predicting fetal survival. Data have been collected on this and other antepartum testing procedures for more than 20 years. Testing methods usually are evaluated by comparing the false-negative mortality rate for each method. The false-negative mortality rate is defined as the number of fetal deaths, corrected for lethal congenital anomalies and unpredictable causes of demise, that occur within 1 week of a normal test result.
The BPP has a false-negative mortality rate of 0.77 deaths per 1000 tests. Furthermore, the BPS highly correlates with the antepartum fetal umbilical venous cord pH level.21,22 Cordocentesis performed immediately following a BPP demonstrated that a poor BPS was always associated with a pH of less than 7.20, while a score of 10 of 10 always yielded a pH of greater than 7.20. The false-negative mortality rate for the nonstress test (NST) alone is 1.9 per 1000 tests, more than twice that of the BPP. The modified BPP has a mortality rate of 0.8. The low false-negative rates of these testing methods depend on an appropriate response to an abnormal result. Intervention and retesting are the usual responses.
Multimedia
 | Media file 1: Reactive nonstress test. The top graph plots the fetal heart rate over time. Each small box represents 10 seconds along the horizontal axis and 10 beats per minute along the vertical axis. The baseline fetal heart rate is from 140-150 beats per minute. This tracing is reactive, since at least 2 accelerations of the fetal heart rate occur within less than 20 minutes. |
|
This feature requires the newest version of Flash. You can download it here. | Media file 2: Fetal breathing movements. Video shows a rhythmic deflection of the fetal chest wall and diaphragm that is clearly distinct from the rhythmic motion of the fetal heart. Note that the image begins in the transverse view, but the ultrasound transducer is then rotated to show a sagittal view and, finally, an oblique view. The episode of continuous fetal breathing lasts well in excess of the required 20-second period. |
|
This feature requires the newest version of Flash. You can download it here. | Media file 3: False fetal breathing movements. Although some transient fetal breathing movements are seen, the video does not include 20 seconds of continuous fetal breathing. Note that the maternal breathing and aortic pulse seen posteriorly and the fetal aortic pulse seen on the sagittal view, along with fetal cardiac activity, can cause deflections of the fetal chest wall, which can be mistaken for fetal breathing movements. |
|
This feature requires the newest version of Flash. You can download it here. | Media file 4: Gross fetal movements and tone. Video demonstrates generalized movements of the fetal lower extremities, including 1 episode of flexion and extension. |
|
This feature requires the newest version of Flash. You can download it here. | Media file 5: Gross fetal movements and tone. Video demonstrates generalized movements of the fetal upper extremities. The upper extremity rests in front of the fetal chest and chin. Although the ultrasound transducer is moving laterally across the maternal abdomen, 2 distinct episodes of flexion and extension are seen. Note the many cross-sectional views of the 3-vessel umbilical cord and the floating echogenic particles of vernix in the amniotic fluid. |
|
This feature requires the newest version of Flash. You can download it here. | Media file 6: Amniotic fluid index. The largest pocket of fluid is measured in each quadrant of the maternal abdomen in the vertical dimension. Then, each value is added to yield the amniotic fluid index. |
Keywords
biophysical profile, antenatal ultrasound fetal surveillance, prenatal ultrasound, BPP, fetal asphyxia, fetal heart rate monitoring, FHR monitoring, FHR, amniotic fluid volume, AFV, antepartum fetal surveillance, biophysical profile score, BPS, nonstress test, antepartum testing, antenatal testing, prenatal testing
More on Biophysical Profile, Ultrasound |
| References |
| Further Reading |
References
ACOG. Antepartum fetal surveillance. In: Practice Bulletin 9. American College of Obstetrics and Gynecology;Oct 1999.
Guimarães Filho HA, Araujo Júnior E, Nardozza LM, Dias da Costa LL, Moron AF, Mattar R. Ultrasound assessment of the fetal biophysical profile: what does an radiologist need to know?. Eur J Radiol. Apr 2008;66(1):122-6. [Medline].
[Best Evidence] Lalor JG, Fawole B, Alfirevic Z, Devane D. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. Jan 23 2008;CD000038. [Medline].
Alfirevic Z, Neilson JP. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;CD000038. [Medline].
Turan S, Turan OM, Berg C, Moyano D, Bhide A, Bower S, et al. Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses. Ultrasound Obstet Gynecol. Oct 2007;30(5):750-6. [Medline].
Manning FA, Platt LD, Sipos L. Antepartum fetal evaluation: development of a fetal biophysical profile. Am J Obstet Gynecol. Mar 15 1980;136(6):787-95. [Medline].
Manning FA. Fetal biophysical profile. Obstet Gynecol Clin North Am. Dec 1999;26(4):557-77, v. [Medline].
Turan S, Miller J, Baschat AA. Integrated testing and management in fetal growth restriction. Semin Perinatol. Jun 2008;32(3):194-200. [Medline].
Manning FA, Morrison I, Lange IR, et al. Fetal biophysical profile scoring: selective use of the nonstress test. Am J Obstet Gynecol. Mar 1987;156(3):709-12. [Medline].
Meis PJ, Ureda JR, Swain M, et al. Variable decelerations during nonstress tests are not a sign of fetal compromise. Am J Obstet Gynecol. Mar 1986;154(3):586-90. [Medline].
Bourgeois FJ, Thiagarajah S, Harbert GM Jr. The significance of fetal heart rate decelerations during nonstress testing. Am J Obstet Gynecol. Sep 15 1984;150(2):213-6. [Medline].
Graves CR. Antepartum fetal surveillance and timing of delivery in the pregnancy complicated by diabetes mellitus. Clin Obstet Gynecol. Dec 2007;50(4):1007-13. [Medline].
Peeters LL, Sheldon RE, Jones MD Jr, et al. Blood flow to fetal organs as a function of arterial oxygen content. Am J Obstet Gynecol. Nov 1 1979;135(5):637-46. [Medline].
Rabinowitz R, Persitz E, Sadovsky E. The relation between fetal heart rate accelerations and fetal movements. Obstet Gynecol. Jan 1983;61(1):16-8. [Medline].
Flack NJ, Dore C, Southwell D, et al. The influence of operator transducer pressure on ultrasonographic measurements of amniotic fluid volume. Am J Obstet Gynecol. Jul 1994;171(1):218-22. [Medline].
Rutherford SE, Phelan JP, Smith CV, Jacobs N. The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol. Sep 1987;70(3 Pt 1):353-6. [Medline].
Phelan JP, Smith CV, Broussard P, Small M. Amniotic fluid volume assessment with the four-quadrant technique at 36- 42 weeks'' gestation. J Reprod Med. Jul 1987;32(7):540-2. [Medline].
Eden RD, Seifert LS, Kodack LD, et al. A modified biophysical profile for antenatal fetal surveillance. Obstet Gynecol. Mar 1988;71(3 Pt 1):365-9. [Medline].
Nageotte MP, Towers CV, Asrat T, Freeman RK. Perinatal outcome with the modified biophysical profile. Am J Obstet Gynecol. Jun 1994;170(6):1672-6. [Medline].
Miller DA, Rabello YA, Paul RH. The modified biophysical profile: antepartum testing in the 1990s. Am J Obstet Gynecol. Mar 1996;174(3):812-7. [Medline].
Vintzileos AM, Gaffney SE, Salinger LM, et al. The relationships among the fetal biophysical profile, umbilical cord pH, and Apgar scores. Am J Obstet Gynecol. Sep 1987;157(3):627-31. [Medline].
O''Leary JA, Andrinopoulos GC, Giordano PC. Variable decelerations and the nonstress test: an indication of cord compromise. Am J Obstet Gynecol. Jul 15 1980;137(6):704-6. [Medline].
Baskett TF. Gestational age and fetal biophysical assessment. Am J Obstet Gynecol. Feb 1988;158(2):332-4. [Medline].
Bocking A, Adamson L, Cousin A, et al. Effects of intravenous glucose injections on human fetal breathing movements and gross fetal body movements at 38 to 40 weeks'' gestational age. Am J Obstet Gynecol. Mar 15 1982;142(6 Pt 1):606-11. [Medline].
Boylan P, Lewis PJ. Fetal breathing in labor. Obstet Gynecol. Jul 1980;56(1):35-8. [Medline].
Campbell K. Ultradian rhythms in the human fetus during the last ten weeks of gestation: a review. Semin Perinatol. Oct 1980;4(4):301-9. [Medline].
Castillo RA, Devoe LD, Ruedrich DA, Gardner P. The effects of acute alcohol intoxication on biophysical activities: a case report. Am J Obstet Gynecol. Mar 1989;160(3):692-3. [Medline].
de Vries JI, Visser GH, Mulder EJ, Prechtl HF. Diurnal and other variations in fetal movement and heart rate patterns at 20-22 weeks. Early Hum Dev. Nov 1987;15(6):333-48. [Medline].
Eglinton GS, Paul RH, Broussard PM, et al. Antepartum fetal heart rate testing. XI. Stimulation with orange juice. Am J Obstet Gynecol. Sep 1 1984;150(1):97-9. [Medline].
Freeman RK, Anderson G, Dorchester W. A prospective multi-institutional study of antepartum fetal heart rate monitoring. I. Risk of perinatal mortality and morbidity according to antepartum fetal heart rate test results. Am J Obstet Gynecol. Aug 1 1982;143(7):771-7. [Medline].
Freeman RK, Garite TJ, Nageotte MP. Basic pattern recognition. In: Fetal Heart Rate Monitoring. 2nd ed. Baltimore, Md: Williams & Wilkins;1991:69-92.
Freeman RK, Garite TJ, Nageotte MP. Instrumentation and artifact detection. In: Fetal Heart Rate Monitoring. 2nd ed. Baltimore, Md: Williams & Wilkins;1991:35-57.
Habek D, Salihagic A, Jugovic D, Herman R. Doppler cerebro-umbilical ratio and fetal biophysical profile in the assessment of peripartal cardiotocography in growth-retarded fetuses. Fetal Diagn Ther. 2007;22(6):452-6. [Medline].
Hanley ML, Vintzileos AM. Biophysical testing in premature rupture of the membranes. Semin Perinatol. Oct 1996;20(5):418-25. [Medline].
Lin CC, Pielet BW, Poon E, Sun G. Effect of magnesium sulfate on fetal heart rate variability in preeclamptic patients during labor. Am J Perinatol. Jul 1988;5(3):208-13. [Medline].
Manning FA. Fetal biophysical profile. Obstet Gynecol Clin North Am. Dec 1999;26(4):557-77, v. [Medline].
Manning FA, Platt LD. Maternal hypoxemia and fetal breathing movements. Obstet Gynecol. Jun 1979;53(6):758-60. [Medline].
Manning FA, Snijders R, Harman CR, et al. Fetal biophysical profile score. VI. Correlation with antepartum umbilical venous fetal pH. Am J Obstet Gynecol. Oct 1993;169(4):755-63. [Medline].
Murata Y, Martin CB Jr, Ikenoue T, et al. Fetal heart rate accelerations and late decelerations during the course of intrauterine death in chronically catheterized rhesus monkeys. Am J Obstet Gynecol. Sep 15 1982;144(2):218-23. [Medline].
Natale R, Clewlow F, Dawes GS. Measurement of fetal forelimb movements in the lamb in utero. Am J Obstet Gynecol. Jul 1 1981;140(5):545-51. [Medline].
Natale R, Patrick J, Richardson B. Effects of human maternal venous plasma glucose concentrations on fetal breathing movements. Am J Obstet Gynecol. Sep 1 1978;132(1):36-41. [Medline].
Nicolaides KH, Peters MT, Vyas S, et al. Relation of rate of urine production to oxygen tension in small-for- gestational-age fetuses. Am J Obstet Gynecol. Feb 1990;162(2):387-91. [Medline].
Peaceman AM, Meyer BA, Thorp JA, et al. The effect of magnesium sulfate tocolysis on the fetal biophysical profile. Am J Obstet Gynecol. Sep 1989;161(3):771-4. [Medline].
Ribbert LS, Visser GH, Mulder EJ, et al. Changes with time in fetal heart rate variation, movement incidences and haemodynamics in intrauterine growth retarded fetuses: a longitudinal approach to the assessment of fetal well being. Early Hum Dev. Jan 1993;31(3):195-208. [Medline].
Further Reading
Growth disturbances: risk of intrauterine growth restriction.
American College of Radiology. 1996 (revised 2007). 10 pages. NGC:006006
Ultrasound scanning during pregnancy.
Finnish Medical Society Duodecim. 2000 Apr 3 (revised 2004 Jun 28). Various pagings. [NGC Update Pending] NGC:004106
Intrapartum fetal heart rate monitoring.
American College of Obstetricians and Gynecologists. 2005 Dec. 9 pages. NGC:005707
Keywords
biophysical profile, antenatal ultrasound fetal surveillance, prenatal ultrasound, BPP, fetal asphyxia, fetal heart rate monitoring, FHR monitoring, FHR, amniotic fluid volume, AFV, antepartum fetal surveillance, biophysical profile score, BPS, nonstress test, antepartum testing, antenatal testing, prenatal testing
