Normal Biophysical Profile Research Articles

Fetomaternal Outcomes of Low-Risk Females Presenting with Perceived Reduced Fetal Movements at Moi Teaching and Referral Hospital, Eldoret, Kenya

Objective: To determine the fetomaternal outcomes of low-risk females presenting with perceived reduced fetal movements at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: This was a cross-sectional study among 133 females of gestation between 34–41 weeks presenting with a perception of reduced fetal movement, who were consecutively recruited. Pearson χ2 and Fischer’s exact tests of association were used to test the association between the non-stress test (NST) findings, biophysical profile (BPP) scores, and fetomaternal outcomes, where p≤0.05 was considered statistically significant. Results: A reactive NST finding was seen in 88 (66.2%) participants with 104 (78.2%) of all participants enrolled having a normal BPP score. Active management of the current pregnancy was offered to 89 (66.9%) of the participants, and 81 (60.9%) of the females had a vaginal delivery. Three quarters (76.7%) of the newborns had a 5-minute appearance, pulse, grimace, activity, and respiration (APGAR) score ≥7, 18 (13.5%) were resuscitated, 13 (9.8%) were admitted to the newborn unit, and four (3%) fresh stillbirths were noted. Both NST (p<0.001) and BPP (p<0.001) were good predictors of a 5-minute APGAR score ≥7, but poorly (p=0.086) predicted resuscitation. There was a statistically significant association between the NST findings and admission to newborn unit (p=0.034). Conclusion: A reactive NST is a good predictor of a 5-minute APGAR score greater than 7, and is associated with a reduced likelihood of both admission to the newborn unit and newborn resuscitation. Both reactive NST and normal BPP are good predictors of vaginal delivery as opposed to Caesarean delivery.

VP45.27: Lung ultrasound in pregnant women with COVID‐19 as the unique lung imaging modality

Lung ultrasound (LUS) has been suggested as a safe, cheap, reliable and accurate tool for assessing the lungs in patients with COVID-19 pneumonia. We hereby present a pregnant woman with COVID-19, in which LUS was used in the diagnosis and management as the unique imaging technique. A 33-year-old primigravida presented to the emergency room of our University Hospital at 26 weeks' gestation with low-grade, mild midline chest pain and dyspnea since 4 days. The lady had an oxygen saturation of 98% at pulse oximetry at presentation. Obstetrical ultrasound showed a single, normally growing fetus, with good biophysical profile. We performed lung ultrasound which showed pleural thickening and diffuse coalescent B-lines involving both lungs (figure 1a). The patient was admitted to the hospital and underwent an oropharyngeal swab for COVID-19 which later resulted positive. During the following four days of admission, the woman showed no symptoms, normal oxygen saturation and rare episodes of low-grade fever. The fetus showed normal biophysical profile all days. A repeat LUS was performed after four days from admission, which showed a diffuse improvement of the ultrasonographic aspect with thinning of the pleura and only some thin B-lines with no coalescent B-lines (figure 1b). The woman was discharged and stayed in home isolation till she had 2 negative swabs. She is now 32 weeks with a normally evolving pregnancy. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The effect of halogen light stimulation on duration of ultrasound parameters of biophysical profile: a randomized clinical trial.

The objective is to assess if fetal halogen light stimulation can reduce the time needed to obtain a normal biophysical profile (BPP). Patients scheduled for a BPP and who satisfied the inclusion criteria were prospectively randomized to halogen light stimulation and no stimulation groups. The study group was exposed to handheld halogen light for 10s whenever fetal breathing, movement, or tone was absent through the first 5min of BPP. The time required to achieve complete BPP score was recorded. In patients with complete BPP score who had delivery within 1week after the test, perinatal morbidity was examined. A total of 598 patients were randomized (light=302, no light=296). There was no difference between the two groups in terms of gestational age, maternal age, body mass index, and indication for BPP except for preterm labor (light: 9%, no light: 4%, p=0.03). Among the patients who had a normal BPP score (n=507), the mean (light: 7.1±6min, no light: 12.3±8min, p<0.0001) and median (light: 4.3, no light: 8, p=0.004) time needed to complete the BPP score was significantly less in the light stimulation group than the no stimulation group. Perinatal outcomes were not different between groups who had delivery during the first week after BPP. Fetal halogen light stimulation can be utilized to reduce the time needed to complete a BPP. However, further studies should be conducted in order to determine the effect of this method on decreasing non-reassuring test results. The study was submitted to the Registry of Clinical Trials on 04/20/2017 (IRCT2017041633470N1). After IRCT registration on 06/07/2017, we recruited patients from 06/08/2017 till 10/15/2017.

Management and Outcome of Reduced Fetal Movements-is Ultrasound Necessary?

To review the management and outcome of pregnancies of women presenting to obstetrical triage with decreased fetal movements (DFM). A retrospective review of women presenting with DFMs to two large Canadian obstetrical centres with a combined 9490 deliveries per year. The charts were reviewed for compliance with the Canadian guidelines for demographics (age, parity, GA, comorbidities, etc.), pregnancy management (admission vs. discharge, need to deliver), and pregnancy outcomes (mortality, morbidity, GA at delivery, Apgar scores, etc.). Patients who did not comply with the Canadian guidelines (requiring the patient to count six movements within two hours) were not excluded. The charts of 579 patients who self-reported DFMs between January 2012 and December 2012 were reviewed. The distribution of ages was between 18 and 47 year old. The majority of these patients had no comorbidities (454/579). A significant minority of patients had FM in the triage area (231/579). The Canadian guidelines were interpreted differently in the two centres. In one (level 3), the protocol was to have a biophysical profile (BPP) on all patients prior to discharge, whereas in the other (level 2), only patients with a non-reactive non-stress test (NST) and/or oligohydramnios or intrauterine growth restriction (IUGR) underwent a BPP. All patients had an evaluation by an RN and MD and had a NST on arrival. A combination of NST and BPP was performed on 235/579. The frequency of DFM was 6.1% (level 3 centre: 5.6%, level 2 centre: 7.8%). There were 8 stillbirths on arrival. The 187 patients who had a reactive NST and a normal BPP and were sent home did not have a single stillbirth within 2 weeks. In the level 3 centre, 19 patients were sent home without a BPP and one had a stillbirth within 2 days (5%); in the level 2 hospital, there was only one stillbirth among the NST-only group (0.35%). There were 65 admissions; 46 of them (71%) were delivered, and 50% of them had a Caesarean delivery (baseline around 30%). This is the first study looking at the performance of the Canadian guidelines of 2007. We found that the DFM rate was compatible with the literature (6.1% vs. 5%). The frequency of stillbirth on arrival was 1.4% (8/579). Patients discharged after normal NST and BPP did extremely well (no stillbirths), whereas those admitted following DFM had a relatively high Caesarean delivery rate (50%). This study was not designed to address changes in stillbirth rate, but it outlines the patients who experience DFM and their eventual outcomes.

Preeclampsia: A Possible Complication of Primary Hyperparathyroidism.

Background. Primary hyperparathyroidism is rare in pregnancy. An association between primary hyperparathyroidism and preeclampsia has been reported in few cases worldwide. Case. A 28-year-old woman (gravida 2, para 0, and abortus 1) in her 27th week of gestation was hospitalized due to a high reading of blood pressure (194/115 mmHg) that was not accompanied by any symptoms or signs of preeclampsia. Incidentally, she was found to have a high adjusted calcium and serum parathyroid hormone (PTH) level during admission. Ultrasonographic examination of the neck revealed the presence of parathyroid adenoma. She was scheduled for surgical excision after receiving an intravenous hydration. Fetal ultrasonography revealed a growth restricted fetus with normal biophysical profile. On the sixth day of hospitalization, the patient complained of headache and epigastric pain, with elevated BP and proteinuria. The fetal nonstress test was “nonreassuring.” Subsequently, she had an emergency cesarean delivery and surgical removal of the adenoma. The mother and her newborn were then transferred to intensive care, where their clinical course was unremarkable. The mother was discharged after 3 days, while the neonate stayed for close observation for 60 days. Conclusion. Early recognition of primary hyperparathyroidism among women with preeclampsia is important to prevent maternal and fetal morbidity and mortality.

Doppler changes as the earliest parameter in fetal surveillance to detect fetal compromise in intrauterine growth-restricted fetuses.

It is estimated that 3-10% of infants are growth restricted. Growth disturbances may have long-term issues. Doppler allows insight into the fetal response to intrauterine stress. The aim of this study was to detect fetal compromise in intrauterine growth-restricted (IUGR) fetuses by means of biophysical profile (BPP) vis-à-vis Doppler velocimetry studies of the fetal umbilical artery, and to find out which of the two is a better and earlier predictor of fetal compromise. A prospective study was conducted on a total of 50 singleton pregnancies with IUGR between 28 and 42 weeks of gestation. Study patients were managed expectantly with nonstress testing and amniotic fluid assessment, BPP and Doppler velocimetry studies of the fetal umbilical artery. Fetal outcome was poor in 5/50 (10%) of the fetuses, defined as presence of all of the following: poor Apgar test score, neonatal intensive care unit stay, necrotizing enterocolitis, and low birth weight. Of the four with abnormal BPP, 50% had poor fetal outcomes. Out of 46 with normal BPP, 6.5% had poor fetal outcomes. Inference drawn from the study is that the Doppler technology provides us the opportunity for repetitive noninvasive hemodynamic monitoring in IUGR pregnancies.

770: Toll-like receptor gene family expression on maternal neutrophils is down-regulated in normal and preeclamptic pregnancies

are provided in table. There was no significant effect of acetaminophen on either fetal breathing or body movements when the data was expressed as number of activity episodes, total activity time, percent of activity time, or activity rate. In addition, there was no effect of acetaminophen when fetal breathing and body movements were combined into a single composite activity score. There were no differences in the proportion of fetuses demonstrating breathing or movement sufficient to achieve a normal biophysical profile score for that parameter, nor was their a difference in time required to achieve a normal score. CONCLUSION: Acetaminophen does not impact fetal breathing or body movements in humans when given at normally prescribed doses. Thus, assessment of fetal well-being using biophysical parameters should not be effected by maternal acetaminophen use.

622: Integrated fetal testing predicts all unexpected stillbirths in fetal growth restriction (FGR)

Stillbirth (SB) rate in the week following normal biophysical profile (BPP) is 0.9/1000 tests. As growth restricted fetuses deteriorate, they show characteristic cardiovascular responses that not detectable by BPP application, leading to unexpected SB if testing intervals are not adjusted. We tested the hypothesis that combined Doppler and BPP (integrated fetal testing=IFT) predicts these unexpected stillbirths in FGR.

625: Biophysical profile in the management of intrauterine growth-restricted fetuses with birth weights less than 1000 grams

RESTRICTED FETUSES WITH BIRTH WEIGHTS LESS THAN 1000 GRAMS SATINDER KAUR, FARHAN HANIF, KATHRYN DRENNAN, RATI CHADHA, MICHAEL KRUGER, GIANCARLO MARI, Wayne State University, Obstetrics & Gynecology, Detroit, Michigan, Wayne State University, Obstetrics and Gynecology, Detroit, Michigan, Wayne State University, OB/GYN, Detroit, Michigan OBJECTIVE: The aim of this study was to determine the biophysical profile (BPP) usefulness in predicting cord pH, base excess (BE), and guidance regarding the timing of delivery in preterm IUGR fetuses. STUDY DESIGN: Forty-eight IUGR fetuses were observed using daily BPP and fetal heart rate (FHR) monitored every 8 hours until delivery. If the FHR monitoring was non-reassuring, a BPP was repeated. A BPP was performed in all patients within 24 hours of cesarean delivery, and considered abnormal when it was 2/10 on one single occasion, or 4/10 in 2 consecutive occasions 2 hours apart. Spearman’s correlation was used for statistical analysis (p 0.05 considered significant). RESULTS: Gestational age of the study population at delivery ranged from 24 to 31.5 weeks (median: 28 weeks). Birth weight ranged between 320 grams and 1000 grams (Median: 620 grams). The last BPP correlated well with arterial cord pH at delivery (R2: 0.50; P 0.05), and arterial BE (R2: 0.47; P 0.05). Of the 30 fetuses with a normal BPP within the last 24 hours, 3 fetuses died in-utero, and 17 fetuses had abnormal pH and BE values at birth. In 10 other fetuses a BPP was repeated because of non-reassuring FHR monitoring. BPP was 2/10 in all 10 cases. At cesarean delivery, 7 of these cases had an abnormal pH and base excess. The other three fetuses died in-utero. Five other fetuses were delivered because of an abnormal BPP. These fetuses had normal cord arterial pH and BE at birth. CONCLUSION: This data indicates that (a) BPP alone is not a reliable test in the management of preterm IUGR fetuses, because of high false positive and negative results; (b) the common notion of a good BPP providing reassurance for at least 24 hours is not applicable in preterm IUGR fetuses 1000 grams.

BIOPHYSICAL SCORE

A pregnancy is defined as high risk when there is a likelihood of anadverse outcome to the woman and or her baby that is greater than the incidence of that outcome in the generalpregnant population. Objectives: To determine the efficacy and predictive value of biophysical profile in detectingperinatal outcome. Design: Observational study. Setting: Obstetrics and Gynaecology department, PNS SHIFA KarachiPeriod: From February 2003 to October 2003. Patients and Methods: The study was carried on 100 randomlyselected high risk pregnant patients who reported to gynae OPD or were referred from different armed forces hospitalsfrom all over sindh . Manning’s biophysical profile excluding nonstress test and including only ultrasound basedparameters were employed for fetal screening ( BPS 8/8). These parameters include four variables i.e fetal breathingmovement, fetal tone, fetal movements, and amniotic fluid volume. Nonstress test and Doppler studies were used asbackup tests where biophysical profile was abnormal. All cases selected were admitted in the hospital and each hadan admission biophysical profile followed by subsequent monitoring. Parameters for abnormal perinatal outcome includefetal distress in labour, five minute apgar score less than 7/10, admission of newborn to intensive care unit and stillbirthor neonatal death. The result of last biophysical profile is compared with perinatal outcome. For statistical analysis thepredictive value, specificity and sensitivity are used to determine the ability of biophysical profile to predict an abnormalperinatal outcome. Results: Out of 100 cases 92 had a normal biophysical profile in the last scan of 8/8. 90 cases hada normal perinatal outcome with A/S &gt; 7/10. In two cases A/S at 1 and 5 minute is &lt; 7/10 with one baby shifted tonursery for delayed cry. 08 cases had an abnormal biophysical profile with scores of 4/8 and 2/8. There was one falsepositive who showed abnormal biophysical profile but baby was born with an A/S of 8/10 at 05 minutes. There was noneonatal death in this study group. The sensitivity of biophysical profile was 77.7%, specificity 98.90%. predictive valuefor a positive test was 87.5%, predictive value for a negative test was 97.8%. Conclusion: Biophysical profile is highlyaccurate and reliable test of diagnosing fetal status.

Management of fetuses with absent/reversed end-diastolic flow (AREDF) in the umbilical artery: outcome of a policy of daily biophysical profile (BPP)

This study aimed to evaluate a management strategy of daily BPP for fetuses with AREDF in the umbilical artery. This was a retrospective review (1994–2002) of outcome in 133 non-anomalous fetuses with AREDF referred to a tertiary centre. Delivery was timed on the basis of an abnormal BPP or gestation > 34 weeks. The mean (SD) gestation at diagnosis was 28.8 (4.4) weeks, and at delivery was 30.4 (4.2) weeks. There were 42 (32%) perinatal deaths, including 30 (23%) in-utero deaths [birth weight 521 (196) g], seven (5%) neonatal deaths [715 (128) g] and seven (5%) terminations of pregnancy [389 (141) g]. Mean birth weight of surviving infants was 1326 (727) g. For the 96 livebirths, 20 (21%) were delivered at gestation ≥ 34 weeks, 11 (11%) for pre-eclampsia and 44 (46%) for abnormal biophysical monitoring (17 for a BPP score =4/10, nine for two equivocal BPPs (score 6/10) and 18 for a single equivocal BPP (of which the key prompt in eight was a pathological CTG). A pathological CTG prompted delivery in a further 12 fetuses where the ultrasound components of the BPP were normal (i.e. 8/8). There was one abruption, and eight (8%) babies delivered for other reasons. ‘Unexpected’ IUDs (i.e. within 24 hours of a normal BPP) occurred in five (4%) cases between 26+1 and 29+0 weeks. These pregnancies were complicated by either proteinuric hypertension (three) or preterm amniorhexis (two). In one case, an equivocal BPP was not repeated within 24 hours.

Fetal death after normal biophysical profile score: An eighteen-year experience

Objective: It was our goal to determine the false-negative rate of the biophysical profile, characterize an 18-year variation in the false-negative rate, examine the relationship between the last normal biophysical profile score and death, and compare the false-negative rate of 2 disparate populations. Study Design: Biophysical profile scores of 86,955 patients at 2 medical centers were collected and recorded prospectively. All perinatal deaths occurring within 1 week of a normal score were similarly recorded. The annual false-negative rate, the cumulative false-negative rate, and the ratio of false-negative results in cases of subsequent fetal death to the perinatal mortality rate were calculated. Results: There were 65 fetal deaths among 86,955 fetuses. Over an 18-year study period at one institution, the false-negative rate varied but not significantly. The cumulative false-negative rate was 0.708 per 1000 at one medical center studied and 2.289 per 1000 at the other center. The average interval between last normal score and fetal death was 3.62 days and did not vary significantly between the medical centers. Conclusions: False-negative results in cases of subsequent fetal death reflect events that are subsequent to the last normal test result. Fetomaternal hemorrhage was the single most identifiable fetal cause of false-negative results in cases of subsequent fetal death. The ratio of the false-negative rate in cases of subsequent fetal death to the perinatal mortality rate should be used as a more objective approach to reporting this value, because the false-negative rate likely reflects the underlying perinatal mortality. (Am J Obstet Gynecol 1999;181:1231-6.)

Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations

OBJECTIVE: The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets). STUDY DESING: A retrospective review was performed of patients with triplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primar method of fetal surveillance in thes pregnancies. Fetal heart rate monitoring on an external monitor wasused as back-up and in cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nonstress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8 8 was therefore considered reassuring. 4 8 equivocal, and 0 or 2 8 possibly abnormal. Testing was done twice per week. RESULTS: Eighteen patients with triplets and six patients with quadruplets constituted the study group. The last biophysical profile before delivery was examined to evaluate the value of the test. There was no antepartum deaths in these 78 babies. The last biophysical profile score was 2 8 in nine fetuses of five triplet pregnancies and two fetuses of one quadruplet pregnancy. These six pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortality in the 19 babies delivered because of abnormal biophysical profile testing. Four pregnancies had poor outcome at delivery in spite of 8 8 biophysical profile scores on all babies within 4 days of delivery. Of these four, two patients had worsening pregnancy-induced hypertension, one had abruptio placentae, and one had a severely growth-retarded infant. CONCLUSION: There were no stillbirths in this series. Twenty-five percent of these pregnancies eventually were delivered for nonreassuring biophysical profile testing, with good outcome. Four pregnancies had poor neonatal outcome in spite of normal biophysical profile testing. All of these pregnancies had active changes in physiologic features leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labor). The biophysical profile appears to be a reliable antepartum test of fetal well-being in triplets and quadruplets.

The clinical significance of a nonreactive nonstress test followed by a normal biophysical profile: [formula omitted]∗, J. Harrigan, E. Smith ∗, Jersey Shore Medical Center, Neptune, NJ

The clinical significance of a nonreactive nonstress test followed by a normal biophysical profile: [formula omitted]∗, J. Harrigan, E. Smith ∗, Jersey Shore Medical Center, Neptune, NJ

Fetal Death After Normal Biophysical Profile

Presented are three cases of fetal death, all of which occurred within 3 days of a normal biophysical profile. Despite the excellent record of this antepartum test in predicting fetal well-being, there is a low incidence of false-negative tests; increasing the frequency of testing will not prevent all false-negative tests.

424 Predictive reliability of normal biophysical profile (BPP) following vibroacoustic stimulation (VAS) is equivalent to normal BPP without VAS

424 Predictive reliability of normal biophysical profile (BPP) following vibroacoustic stimulation (VAS) is equivalent to normal BPP without VAS

Outcome of Fetuses with Abnormal Biophysical Profile

Sonographic observation of fetal behavior as a possible indicator for the state of fetal health was quantified with a modified biophysical profile (BPP). The observation time was extended to 40 min, as the fetal rest-activity cycle implies that inactivity may last that long. Gestational age ranged 27–43 weeks. Cardiotocography (CTG) was performed subsequent to an abnormal BPP (ultrasound score 0–4). Reactivity, indicating favorable fetal outcome, was more common in near-term fetuses, suggesting that BPP should be interpreted in relation to gestational age. Therefore, fetuses with an abnormal BPP (n = 29) were each matched and compared with 2 fetuses of same gestational age but normal BPP (ultrasound score 6–8; n = 58). The perinatal mortality and morbidity were significantly higher in infants with abnormal score than in infants with normal score (p < 0.01). BPP by third trimester sonography helps to diagnose acutely endangered fetuses, and an abnormal fetal movement pattern should lead to further evaluation, i.e. CTG. While BPP scoring, as compared to CTG, is less favorable as a primary surveillance technique and not superior for identifying the hypoxic fetus, additional information is obtained with BPP by diagnosing the growth-retarded and/or malformed fetus.

Fetal surveillance in insulin-dependent diabetic pregnancy: Predictive value of the biophysical profile

Ninety-eight insulin-dependent diabetic pregnancies underwent monitoring by means of 978 biophysical profiles from 28 weeks' gestation until parturition. Only 2.9% of the 978 tests had abnormal results (score ,;;;7). When performed within 2 days before birth, a normal biophysical profile predicted the 1-minute Apgar score to be normal in 92% and 5-minute Apgar score in 99%. When all biophysical profiles ever performed were included, the predictive value improved to 100%. The baby's first cry within 1 minute after birth was predicted in 95%. Furthermore, the predictive value of a normal biophysical profile regarding the absence of ominous intrapartum cardiotocographic patterns was exceHent (95%). The specificity was in general good (80% to 90%), but the predictive value of abnormal test results and sensitivity were almost without exception poor. It seems that the very low rate of abnormal biophysical profiles indicates that obstetric interventions were made immediately after the occurrence of the first sign of fetal jeopardy; thus improved results were Obtained. (AM J 0BSTET GYNECOL 1988;159:800-4.)

Sinusoidal Heart Rate Pattern and an Normal Biophysical Profile in a Severely Compromised Fetus

Sinusoidal Heart Rate Pattern and an Normal Biophysical Profile in a Severely Compromised Fetus

Outcome of Fetuses with Abnormal Biophysical Profile

Sonographic observation of fetal behavior as a possible indicator for the state of fetal health was quantified with a modified biophysical profile (BPP). The observation time was extended to 40 min, as the fetal rest-activity cycle implies that inactivity may last that long. Gestational age ranged 27-43 weeks. Cardiotocography (CTG) was performed subsequent to an abnormal BPP (ultrasound score 0-4). Reactivity, indicating favorable fetal outcome, was more common in near-term fetuses, suggesting that BPP should be interpreted in relation to gestational age. Therefore, fetuses with an abnormal BPP (n = 29) were each matched and compared with 2 fetuses of same gestational age but normal BPP (ultrasound score 6-8; n = 58). The perinatal mortality and morbidity were significantly higher in infants with abnormal score than in infants with normal score (p less than 0.01). BPP by third trimester sonography helps to diagnose acutely endangered fetuses, and an abnormal fetal movement pattern should lead to further evaluation, i.e. CTG. While BPP scoring, as compared to CTG, is less favorable as a primary surveillance technique and not superior for identifying the hypoxic fetus, additional information is obtained with BPP by diagnosing the growth-retarded and/or malformed fetus.