Fetal Biophysical Profile Score Research Articles

Does antenatal betamethasone have negative effects on fetal activities and hemodynamics in cases of preeclampsia without severe features? A prospective, placebo-controlled, randomized study

Aim: To evaluate whether antenatal betamethasone affects the fetal biophysical profile (BPP) and Doppler indices of umbilical and middle cerebral arteries (MCAs) in cases of preeclampsia without severe features. Materials and methods: Forty singleton preeclamptic pregnancies without severe features at gestational ages of 28–34 weeks were randomly divided into two groups of 20 patients: betamethasone and control groups. Patients in the betamethasone group were administered two consecutive doses of 12 mg betamethasone intramuscularly, 24 h apart, and patients in the control group were administered the same volume of saline as a placebo. All participants were evaluated before (0 h) and at hours 24, 48, and 72 of betamethasone/placebo administration using BPP scoring and umbilical and MCA Doppler examinations. Results: Total BPP scores were significantly lower in the betamethasone group across the three time points during the follow-up period (p < 0.001). None of the Doppler indices differed significantly between the groups (p > 0.05). Conclusion: Antenatal betamethasone negatively affects fetal BPP score parameters, including the non-stress test, fetal body and breathing movements, without affecting vascular indices of umbilical arteries and MCAs. Clinician awareness of this transient drug-induced effect might be valuable for preventing iatrogenic preterm delivery for fetuses in preeclamptic pregnancies without severe features.

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Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores

It was aimed to investigate the effects of short-term maternal fasting on fetal biophysical profile (BPP) scores and obstetric doppler indices. Thirty healthy uncomplicated singleton pregnancy cases were enrolled into the study. Fasting decreased BPP reversibly, but not to a level below 8/10. AFI, umbilical and MCA impedances were unchanged while pulsatility, resistance and systolic/diastolic values of uterine arteries were increased.

Efecto de la terapia temprana con L-arginina en el crecimiento intrauterino restringido en la preclampsia. Estudio aleatorizado en mujeres latinoamericanas

ObjectiveTo assess the benefit of early L-arginine administration in preeclampsia on the relative risk to fetal growth. Patients and methodsOne-hundred women with preeclampsia were randomized to receive either L-arginine or placebo until the day of delivery. To evaluate the relative risk of intrauterine growth restriction (IUGR) and the effect of L-arginine on this process, 96 live singleton infants of women with preeclampsia (50 with treatment and 46 without treatment) were compared; these infants were also compared with a further 50 control infants of healthy women. Gestational age-related birth weight was compared using standard growth curves. Infants smaller than the 10th percentile were classified as IUGR. The Mann-Witney U-test, ANOVA, and chi-square test were used to evaluate statistically significant differences (P<.05) between the groups. ResultsNo significant differences were found between the groups with preeclampsia before randomization. Preeclampsia was associated with a 21% reduction in birth weight. The risk of IUGR was five times higher in infants born after preeclampsia without L-arginine therapy than in control pregnancies (RR = 5.0; 95%IC: 1.5-16.2) and was two times higher in infants born after preeclampsia with L-arginine therapy (RR = 2.0; 95% CI: 1.9-7.6). The fetal biophysical profile and Apgar score were significantly more favorable in the L-arginine group (P<.05). ConclusionFetal growth markedly improves with early L-arginine therapy in women with preeclampsia.

Antithrombin improves fetal condition in women with severe pre‐eclampsia before 32 weeks of gestation; a randomized, double‐blind, placebo‐controlled trial

To see if antithrombin (AT) supplementation improved fetal outcomes in early onset (<32 weeks) severe pre-eclampsia. A subgroup re-analysis of an original randomized controlled trial of AT in pre-eclampsia between 24 and 35 weeks of gestation was performed. Either AT (3000 IU/day, n=42) or placebo (Albumin 582 mg/day, n=42) were administered for 7 days. Fetal weight gain, biophysical profile score and fetal heart rate monitoring were evaluated during the treatment week and until delivery. Comparisons were performed by intent-to-treat and relative risk (RR) and 95% Confidence Intervals (CI) were obtained. In each group, 27 women (64%) completed the allocated intervention. AT significantly decreased the worsening of the fetal biophysical profile score or fetal heart rate monitoring (RR 0.24, 95% CI 0.07-0.8), increased the incidence of estimated weight gain >15 g/day during the intervention week (3.1, 1.0-9.9), and prolonged gestational age to >or= 34 weeks (3.6, 1.05-12.6), however infant mortality rates did not differ between the two groups. No adverse events related to AT were observed. Supplementation of AT preserves fetal biophysical condition and weight gain in early onset severe pre-eclampsia and most likely prolongs pregnancies >or= 34 weeks of gestation.

Doppler Cerebro-Umbilical Ratio and Fetal Biophysical Profile in the Assessment of Peripartal Cardiotocography in Growth-Retarded Fetuses

Objective: The aim of the study was to examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of peripartal cardiotocography (CTG) in growth-retarded fetuses. Methods: The prospective study included 58 pregnant women with singleton pregnancy from 28 to 42 weeks of gestation with clinically and ultrasonically verified late intrauterine growth retardation (IUGR). After assessment of the FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and the FBP were assessed twice a week. The last peripartal CTG was used as an outcome parameter. Results: The FBP score was statistically significant when associated with peripartal CTG (p < 0.001). The mean value of the FBP was 7.77 ± 0.28 for infants with a normal peripartal CTG, 6.13 ± 0.41 for infants with a prepathological CTG and 4.40 ± 0.60 for infants with a pathological peripartal CTG. There was also a statistically significant association between the C/U ratio ≧1 and normal CTG (p < 0.005), but there was no statistically significant difference between prepathological and pathological CTG in relation to C/U ratio values (p > 0.05). Normal and pathological peripartal CTG was correlated with the perinatal outcome, but prepathological CTG was not correlated with results of the perinatal outcome (p > 0.05). Conclusions: Our results showed that both methods of fetal monitoring need to be used in perinatal monitoring of growth-retarded fetuses. The two methods can be used as important parameters in deciding to end pregnancies with IUGR when pathological values occur.

The Actifetus System: A Multidoppler Sensor System for Monitoring Fetal Movements

Fetal heart rate (FHR) monitoring is a crucial part of monitoring at-risk pregnancies and labor. Its aim is to detect any abnormalities that might indicate acute fetal distress and a need for rapid treatment to avoid death or serious sequelae, including cerebral handicap. The use of fetal biophysical profiles in high-risk pregnancies (gravidic hypertension, in utero infection, etc.) helps to distinguish healthy fetuses from those with chronic conditions. Fetal biophysical profile scores have been developed that integrate five biophysical parameters, one of which is derived from the FHR. The major parameters detected are the rate of fetal movements, fetal tone, fetal breathing movement and amniotic fluid volume. All of those parameters except FHR are obtained by prolonged echographic observation and cannot be used routinely. We developed in this study a new multigate multitransducer pulsed Doppler system for survey of fetal behavior. Fast Fourier transform and autocorrelation function have been used for processing and analyzing ultrasonic Doppler signals generated by fetal movements. Several parameters are analyzed in each of the 12 × 5 = 60 Doppler gates: amplitude of signals reflected by moving fetal structures, velocity, direction and amplitude of displacement of fetal structure (heart, chest, limbs). From these parameters it is possible to calculate FHR and characterize fetal activity. Preliminary in vivo results obtained in 15 pregnant women (30 to 36 wk) are very encouraging but they have yet to be confirmed in future studies. These results also demonstrate the advantages of transducers designed for improved fetal movement detection. The algorithms needs to be precise enough to allow the Actifetus system to function in real time. We now have at our disposal some algorithms that succeed in quantifying FHR and fetal movements with a signal from a given sensor at a given depth. This study confirms the feasibility of monitoring fetal movements by the Actifetus system and demonstrates the importance of the characterization of fetal rhythms (and fetal behavior). The Actifetus system will serve as a new mean for studying fetal response to environment and detecting anomalies related to fetal suffering. (E-mail: ali.kribeche@med.univ-tours.fr)

Diminution des mouvements actifs du fœtus au troisième trimestre : que faire ?

To appreciate at the end of pregnancy, in a low-risk pregnant population, the interest of a screening for fetal well-being in case of decreased fetal movements. To define the most adapted screening. Retrospective study over a complete year of the patients having consulted in the same center for decreased fetal movements and subjected to the same screening for fetal activity in hospitalization during 48 hours. This screening included a study of fetal heart rate repeated three times a day, a fetal biophysical profile scoring, an umbilical artery Doppler, a Kleihauer-Betke testing, and an amnioscopy. One hundred and sixty patients were identified, representing 6.1% of pregnancies followed in the center. There was no relation between the age, the parity of the patients and the probability to consult for a decrease of fetal movements. Nevertheless the antecedents of pathological pregnancy or fetal malformation were frequent. Twenty-one percent of the deliveries were induced for a global rate of 18% in the center. Twenty-eight percent of the patients had a cesarean section for a global rate of 22.8%. Five percent of fetuses were at risk for prenatal asphyxia on the data of the screening. Fetal heart rate was abnormal in 3.75% of cases, fetal biophysical profile score pathological in 3.1% of cases. Just one umbilical Doppler was highly pathological. No meconium amniotic fluid was found. Two Kleihauer-Betke tests were disturbing. At the time of delivery, 28% of fetuses presented a funicular abnormality, 4.3% a severe growth restriction, 4.3% a malformation. One child only had an anemia. There was no perinatal mortality. Screening for fetal vitality remains necessary in case of decreased fetal movements. It has to associate the study of fetal heart rate and the fetal biophysical profile with a Kleihauer-Betke testing. In a low-risk pregnant population, the study of fetal Doppler velocimetry is not profitable. Amnioscopy presents not enough interest. It is necessary to insist with the patients on the necessity of consulting in case of decreased fetal movements even in the approach of the term.

The effect of glucocorticosteroid administration on fetal movements and biophysical profile scores in normal pregnancies

Objective: To evaluate and quantify the effect of glucocorticosteroid administration on fetal movements and biophysical profile scores.Methods: Eighteen women at 32-34 weeks' gestationwere enrolled. Inclusion criterion was an uncomplicated singleton pregnancy not considered to be at high risk. Patients participated for 3 consecutive days. On day 1, the patients underwent a baseline biophysicalprofile including a non-stress test followed by a 12-mg betamethasone intramuscular injection. On day 2, the patients received a non-stress test and a second dose of betamethasone. On day 3, a biophysicalprofile with non-stress test was performed. Maternal counts of fetal kicks were also recorded before, during and after the study period. Each test was conducted at approximately the same time of day tocontrol for diurnal variation. Comparison was made between pre-betamethasone biophysical profile scores and fetal movement and post-betamethasone biophysical profile scores and fetal movement.Results:Biophysical profile scores were reduced in 28% of the study population after betamethasone administration (p < 0.05). Amniotic fluid index on day 3 was decreased from baseline in 72% of patientsafter betamethasone administration (p < 0.05). Forty-four per cent of patients reported a decrease in fetal movement. Of these patients, 87% had a decreased amniotic fluid index when comparedto baseline (p < 0.05).Conclusions: Fetal movements and breathing motion were decreased after glucocorticosteroid administration, as evidenced by biophysical profile scores and kickcounts. The decrease in the amniotic fluid index observed after glucocorticosteroid administration may have been the result of decreased fetal breathing and, therefore, decreased efflux of alveolar fluidinto the amniotic sac.

P241: The effect of betamethasone administration on maternal and fetal Doppler velocimetry and fetal biophysical profile score

P241: The effect of betamethasone administration on maternal and fetal Doppler velocimetry and fetal biophysical profile score

Fetal biophysical profile: a critical appraisal.

In medicine, in general and fetal medicine in particular, the conceptual development and emerging application of a new diagnostic modality is fuelled firstly by a general recognition of the increasing relative importance of a particular clinical problem and then by critical examination of the body of scientific observation, often disparate in origin, that provides the key insights into the pathophysiology, manifestation and natural history of the disease process. So it is with the evolution of the fetal biophysical profile score. In general terms, until the 1950's the major goal of obstetric care was the prevention of maternal mortality and morbidity. As the result of a host of clinical advances including improved anaesthesia and surgical techniques and availability of blood and blood products, antibiotics and specific other drugs (oxytocin, anticonvulsants, antihypertensives, insulin etc.) maternal mortality declined to the low rates of the present day. Consequently, the focus of obstetric care shifted to the recognition and prevention of death or damage affecting the other patient in the obstetric dyad: the fetus. The first methods for evaluation of antepartum fetal health care were based on measurements of biochemical variables in the maternal compartment (e.g. oestriol, placental lactogen, alkaline phosphatase and oxytocinase).

Fetal assessment based on fetal biophysical profile scoring: VIII. The incidence of cerebral palsy in tested and untested perinates

OBJECTIVE: The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the fetal biophysical profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last fetal biophysical profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN: In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, –coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial fetal biophysical profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded biophysical profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the fetal biophysical profile score were calculated. RESULTS: The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test fetal biophysical profile score was inverse, exponential, and highly significant. CONCLUSIONS: Antepartum assessment by fetal biophysical profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy. (Am J Obstet Gynecol 1998;178:696-706.)

The relationship between umbilical artery Doppler findings, fetal biophysical score and placental inflammation in cases of premature rupture of membranes

To assess the relationship between placental inflammation, umbilical artery Doppler waveforms and fetal biophysical profile score, umbilical artery Doppler studies and fetal biophysical evaluations were performed in 24 preterm pregnants with premature rupture of membranes (PPROM). After delivery, the placentas were microscopically examined and two subgroups were formed including noninflamed or inflamed placentas. In the first group, which includes 14 cases with no histological signs of placental inflammation, we found increased systolic/diastolic ratio only in one patient, whereas in the second group including ten cases with microscopically proven inflammation, nine were found to have increased systolic/diastolic ratios (p < 0.05). Mean systolic/diastolic ratio in the first and the second groups were 2.74 +/- 0.18 and 4.64 +/- 0.93 respectively (p < 0.001). Mean biophysical profile score was 9 +/- 1.04 in the first group and 7 +/- 1.05 in the second group (p < 0.001). Abnormal biophysical profile scores along with increased arterial systolic/diastolic ratios have been shown to be the markers of impending clinical infection.

Fetal biophysical profile: a critical appraisal

In medicine, in general and fetal medicine in particular, the conceptual development and emerging application of a new diagnostic modality is fuelled firstly by a general recognition of the increasing relative importance of a particular clinical problem and then by critical examination of the body of scientific observation, often disparate in origin, that provides the key insights into the pathophysiology, manifestation and natural history of the disease process. So it is with the evolution of the fetal biophysical profile score. In general terms, until the 1950's the major goal of obstetric care was the prevention of maternal mortality and morbidity. As the result of a host of clinical advances including improved anaesthesia and surgical techniques and availability of blood and blood products, antibiotics and specific other drugs (oxytocin, anticonvulsants, antihypertensives, insulin etc.) maternal mortality declined to the low rates of the present day. Consequently, the focus of obstetric care shifted to the recognition and prevention of death or damage affecting the other patient in the obstetric dyad: the fetus. The first methods for evaluation of antepartum fetal health care were based on measurements of biochemical variables in the maternal compartment (e.g. oestriol, placental lactogen, alkaline phosphatase and oxytocinase).

OGO 6007 New facilities in prenatal ultrasound diagnostic program-special modification of fetal biophysical profile scoring

OGO 6007 New facilities in prenatal ultrasound diagnostic program-special modification of fetal biophysical profile scoring

Fetal biophysical profile and vibratory acoustic stimulation in high-risk pregnancies

To determine the influence of the non-stress test (NST) on the efficiency of the fetal biophysical profile (FBP) and to test the clinical usefulness of the FBP and its combination with vibratory acoustic stimulation (VAS) in managing high-risk pregnancies. One hundred twenty fetuses of preeclamptic patients were included in a prospective study. Five standard variables of the FBP were observed ultrasonically following NST. In cases of non-reactive NST, external VAS was applied and the FBP score calculated and compared with the FBP score before VAS. Of 120 calculated FBPs, 102 (85%) had normal profile scores before VAS and 104 (86.7%) after VAS. No statistically significant difference was found. The sensitivity, specificity, and positive and negative predictive values of the FBP score in predicting poor perinatal outcome were 94.7%, 94.4%, 75% and 99%, respectively. VAS produced a high conversion (58.8%) of non-reactive NST to reactive fetal heart rate pattern. The false-negative rate of the FBP score was 9.8 per 1000, which did not increase after VAS. The efficiency of the FBP score was not significantly improved by VAS, although a high conversion of non-reactive to reactive NST was produced. The FBP with its three 'acute biophysical variables' was found to be an accurate method of antepartum assessment even without an NST. The low incidence of perinatal complications among patients with normal FBP scores, permits the conservative management of preterm high-risk pregnancies.

Dynamic Ultrasound-Based Fetal Assessment: The Fetal Biophysical Profile Score

The advent of ultrasound fetal imaging and the evolution of dynamic imaging (real-time) methods have opened great new vistas in which fetal responses can be monitored with remarkable precision and clarity. Contained within this new wealth of information may lie the key to direct determination of the fetus at risk for death or injury in utero. Consideration of fetal activities so plainly recognized by conventional dynamic ultrasound methods and an assessment of fetal environment appear to be integral parts of this process. It is reasonable to assume that composite assessment by the dynamic ultrasound-based PBS will remain a valuable adjunct in caring for the high-risk fetus.

Complicated pregnancies

The search continues for improved methods of detection of fetal distress. This review discusses the use of cord blood erythropoietin, umbilical artery blood velocity waveform, continuous fetal heart rate monitoring, and fetal biophysical profile scoring in the detection of fetal distress. Also discussed are a number of situations where pregnancy is complicated by either obstetric conditions such as breech presentation, vaginal birth after previous caesarean section, or accompanying systemic disease, including previous organ transplantation, cardiac disease, and substance abuse among parturients.

Relationship between the fetal biophysical profile score, umbilical artery Doppler velocimetry, and fetal blood acid-base status determined by cordocentesis

Fetal hypoxia-acidosis is part of the terminal pathway leading to intrauterine fetal death. A central premise of antepartum surveillance is that identification and timely delivery of the hypoxic or acidotic fetus will prevent intrauterine death and decrease long-term neurologic damage. The optimal method to identify fetal hypoxia-acidosis has not been determined. We attempted to compare the performance of the biophysical profile score and umbilical artery Doppler velocimetry in the identification of fetal acidemia, hypoxemia, and hypercarbia as determined by pH and gas analysis of fetal blood obtained by cordocentesis. Fetal biophysical profile and umbilical artery Doppler velocimetry studies were performed before cordocentesis in 24 patients (26 to 40 weeks). Umbilical vein pH and blood gas values were determined in all cases. The pulsatility index of the umbilical artery was obtained with pulsed Doppler equipment. Receiver-operator characteristic curve analysis and stepwise multiple logistic regression were performed to examine the relationship between biophysical profile score, umbilical artery Doppler velocimetry, and acid-base status. The prevalence of fetal acidemia (pH 2 SD below the mean for gestational age) was 41.7% (10/24). There was a significant relationship between the change in umbilical artery pulsatility index and fetal acidemia (chi 2 = 26.6, p < 0.001) and hypercarbia (chi 2 = 22.9, p < 0.001), but not hypoxemia (chi 2 = 1.0, p > 0.1), and between the biophysical profile score and fetal acidemia (chi 2 = 11.1, p < 0.001) and hypercarbia (chi 2 = 9.0, p < 0.005), but not hypoxemia (chi 2 = 2.3, p > 0.1). Stepwise multiple logistic regression demonstrated that umbilical artery Doppler velocimetry was a better explanatory variable for acidemia and hypercarbia than the biophysical profile score. A strong relationship between the degree of fetal acidemia and hypercarbia and the results of umbilical artery Doppler velocimetry and biophysical profile was found. However, umbilical artery Doppler velocimetry was a better explanatory variable for these outcome than the biophysical profile score.

Fetal biophysical profile score: VI. Correlation with antepartum umbilical venous fetal pH

Our objective was to determine the relationship, if any, between the fetal biophysical profile score and antepartum umbilical venous pH. This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal biophysical profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of biophysical profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. In both data sets there was a highly significant linear correlation between biophysical profile score and umbilical venous pH. Poor biophysical profile score performance (a score of 0 of 10) was always associated with a pH < 7.20, whereas the pH was always > 7.20 when the biophysical profile score was 10 of 10. Sequenced sensitivity of short-term biophysical variables in the detection of acidemia was observed. The fetal biophysical profile score accurately predicts antepartum umbilical venous pH.