Module 7.1 : Biophysical Profile BPP Flashcards Preview

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Flashcards in Module 7.1 : Biophysical Profile BPP Deck (51)
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1

BPP

biophysical profile

2

what fetal biophysical activities can we identify on US

- gross body movement
+ rolling of fetal trunk or turning of fetal head
- breathing
+ just practice breathing motion (mom breathes for fetus) and hiccups
- fetal tone
+ flexion and extension of a limb or fingers


* 4th parameter is AMNIOTIC FLUID

3

additional assessments with BPP

- biometry
+ BPD/HC
+ AC
+ FL
- doppler of umbilical artery (when under 50th percentile)
- amniotic fluid volume AFI
- placenta grade or position
- cord position

4

factors affecting BPP score

- asphyxia
- drugs

5

asphyxia

- low oxygen in fetus
- extent or severity will result in low score
- duration or length of time fetus has low oxygen
- frequency of the insult (continuous or intermittent)

6

drugs that affect BPP

- sedatives (barbiturates - opium)
- analgesics (morphine)
- anesthetics (halothane)

7

lack of oxygen on activity centres in brain

- activity centres in the brain that mature first are the last to be affected when low oxygen occurs

8

fetal tone and lack of oxygen

- area in the brain that controls fetal tone develops first and last activity to disappear in asphyxia

9

fetal heart rate and lack of oxygen

- fetal heart rate reactivity centre matures at 28 weeks and first to be affected by asphyxia
- monitored with non stress test (NST)

10

performing the BPP

- observe movement
+ gross fetal movement
+ fetal breathing
+ fetal tone
- measure
+ amniotic fluid pocket

11

purpose of BPP

- performed to asses for fetal hypoxia
+ asphyxia
+ low oxygen levels in the fetus

12

scoring of a BPP

- for each criteria fetus gets a score
+ 2 = does required exercise
+ 0 = element not performed
- fetus allows 30 minutes to perform all elements
- just US BPP out of 8

13

gross fetal movement

- 3 or more gross fetal movements must be seen in 30 minutes to give a score of 2
- if any fewer than gets a 0
- movement = fetal trunk or head moves

14

fetal breathing movement

- 30 seconds of continuous fetal breathing is requires to get score of 2
- fetus can take one 6 second break in the 30 seconds
- hiccups count
- score of zero not reliable indicator of poor fetal well being as they may have long stretches of apnea
- either 2/2 or 0/2
- most frequently not seen on BPP

15

fetal tone

- fetus most demonstrate one episode of flexion and extension
+ arm
+ leg
+ finger
+ toe
+ yawn
- 2/2 or 0/2

16

amniotic fluid pocket

- a pocket >/= 2x2 cm is normal and given a score of 2
- anything less is score of 0
- do not include cord in this measurement

17

the score

- if fetus performs in all of the US criteria it is given a score of 8/8
- if one or more is missed in 30 minute exam it is given 6/8 or 4/8
- patient will go on to have a non stress test
- NST performed in labor and delivery or MFM
- BPP now out of 10

18

are all scores equal ?

- no
- a 6/8 because of lack of fetal breathing is not as concerning
+ NST recommended bust maybe not is growth is normal
- a 6/8 because of lack of amniotic fluid is concerning
+ is pregnancy is post does delivery is recomendded
+ is preterm then bedrest and follow up BPP

19

amniotic fluid index AFI

- method of assessing amount of amniotic fluid in amniotic sac around fetus
- AFI performed during BPP
- does not influence BPP score at all
- amniotic fluid levels help assess placental function

20

factors affecting AFI

- maternal
+ diabetes
+ high blood pressure
- fetal
+ renal abnormalities
+ swallowing difficulties

21

how to evaluate AFI

- sum of depth of all amniotic fluid in 4 quadrants of uterus

22

oligohydramnious

AFI < 5cm

23

polyhydramnios

AFI > 20-25

24

uterus quadrants

- measure vertical depth to the floor
- sequence does not matter
- RLQ, LLQ, RUQ, LUQ

25

any one pocket greater than 8 cm

polyhydramnios

26

non stress test NST

- tracing of fetal heart taken via electrodes on maternal abdomen over area of fetal heart
- not an US test
- performed by obstetrician or fetal assessment nurse
-

27

- what NST is looking for

- increased heart rate with fetal motion with quick return to baseline when activity stops is good indication
- the time it takes for the heat to return the normal is assesed

28

signs of fetal distress

- slow response of fetal heart to return to normal
- no change in fetal heart rate with activity
- heart rate decelerations

29

assessing fetal distress

- at least 2 episodes of acceleration over 15 bpm and at least 15 seconds duration associated with fetal movement in a 30 minute period
- 2 is added to BPP score making it out of 10

30

8/10 or 10/10

- fetal well bein