BPP with UA Dopplers

• Indications:

o Routinely performed on all fetuses 23 weeks and above.

• Biophysical Profile:

o Ultrasound scoring is based on a 30-minute time frame with a maximum score of 8/8

 AFI

 Fetal gross body movements

 Fetal tone

 Fetal breathing movements

o Scoring a BPP:

 At least one amniotic fluid pocket must measure 2cm vertically, and must also measure at least 1cm across to meet criteria.

 Gross body movements:

o 3 or more discrete body or limb movements within 30 minutes

o Fetal trunk movements or “body rolls”.

o A minimum of 2 movements required to meet criteria.

 Fetal tone:

o One or more episodes of active extension and flexion of a fetal extremity OR opening and closing of the hand within 30 minutes

o Extension with immediate flexion. Opening and closing hand, mouth and kicking are examples.

o A minimum of one complete extension/flexion movement required to meet criteria.

 Fetal breathing movements:

o One or more episodes of fetal breathing lasting at least 30 seconds within 30 minutes.

o Rhythmic contractions of the fetal diaphragm causing rise and fall of fetal chest.

o Breathing movements must be sustained for 30 seconds to meet criteria.

• Amniotic Fluid Index (AFI):

o A single deepest vertical pocket of amniotic fluid measures greater than 2 centimeters. is present

o Divide the abdomen in 4 quadrants. Measure the largest vertical pocket of fluid (for each quadrant) not containing fetal parts or umbilical cord.

o Normal AFI is 5-24cm. Low AFI 5.1-7.9 cm. <5cm is oligohydramnios, >24cm ( or a single vertical pocket >8 cm) is polyhydramnios and must be noted on report.

 Contact appropriate Perinate or APN for low AFI or oligohydramnios.

• The ultrasound technique for obtaining AFI is described as follows.

• The patient positioning is supine with the understanding that some of the gravid patients may become very uncomfortable lying horizontally.

• The probe should be held in the sagittal plane and parallel to the bed taking care not to angle the probe cephalad or caudal.

• Procedure to obtain umbilical artery Dopplers:

o Measurements should be made in a free cord loop.

o Use pulsed wave Doppler to obtain waveform.

o Use High Q to measure velocities of a minimum of 3 waveforms.

o Repeat on a minimum of 2 cord segments. Obtain a third measurement if results in one segment are elevated.

o If RI is elevated (>90%) in more than one segment, MCA Doppler and DV Dopplers must be performed.

• NST (nonstress test)

• Included after 28-32 weeks, NST is scored and awarded points for reactivity with a maximum of 10/10. Reactivity is based on number and quality of FHR accelerations during 20-30-minute NST.

• NST’s are to be read by an RN, Nurse Practitioner and/or MD.

o A BPP score of less than 6/8, before 28 weeks must be reported to Perinate or referring physician.

o A BPP score of less than 8/8 at 28 weeks and above requires than an NST be performed.

o A BPP score of less than 8/10 at 28 weeks and above must be reported to referring physician.