Module 7.1 : Biophysical Profile BPP Flashcards
1
Q
BPP
A
biophysical profile
2
Q
what fetal biophysical activities can we identify on US
A
- 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
Q
additional assessments with BPP
A
- biometry \+ BPD/HC \+ AC \+ FL - doppler of umbilical artery (when under 50th percentile) - amniotic fluid volume AFI - placenta grade or position - cord position
4
Q
factors affecting BPP score
A
- asphyxia
- drugs
5
Q
asphyxia
A
- 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
Q
drugs that affect BPP
A
- sedatives (barbiturates - opium)
- analgesics (morphine)
- anesthetics (halothane)
7
Q
lack of oxygen on activity centres in brain
A
- activity centres in the brain that mature first are the last to be affected when low oxygen occurs
8
Q
fetal tone and lack of oxygen
A
- area in the brain that controls fetal tone develops first and last activity to disappear in asphyxia
9
Q
fetal heart rate and lack of oxygen
A
- fetal heart rate reactivity centre matures at 28 weeks and first to be affected by asphyxia
- monitored with non stress test (NST)
10
Q
performing the BPP
A
- observe movement \+ gross fetal movement \+ fetal breathing \+ fetal tone - measure \+ amniotic fluid pocket
11
Q
purpose of BPP
A
- performed to asses for fetal hypoxia
+ asphyxia
+ low oxygen levels in the fetus
12
Q
scoring of a BPP
A
- 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
Q
gross fetal movement
A
- 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
Q
fetal breathing movement
A
- 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
Q
fetal tone
A
- fetus most demonstrate one episode of flexion and extension \+ arm \+ leg \+ finger \+ toe \+ yawn - 2/2 or 0/2
16
Q
amniotic fluid pocket
A
- 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
Q
the score
A
- 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
Q
are all scores equal ?
A
- 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
Q
amniotic fluid index AFI
A
- 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
Q
factors affecting AFI
A
- maternal \+ diabetes \+ high blood pressure - fetal \+ renal abnormalities \+ swallowing difficulties
21
Q
how to evaluate AFI
A
- sum of depth of all amniotic fluid in 4 quadrants of uterus
22
Q
oligohydramnious
A
AFI < 5cm
23
Q
polyhydramnios
A
AFI > 20-25
24
Q
uterus quadrants
A
- 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
31
6/10 or 4/10
- repeat scan in 24 hours
- case per case conditions
+ high risk pregnancies with maternal factors or diseases must be considered
+ may indicate uterine environment harming fetus
+ fetal doppler performed on most of these for further information
32
0/10 0r 2/10
delivery
33
what is the apporpraite gestational age to start doing a BPP
not done prior to 28 weeks
34
is the score alone a indicator of fetal well being
no
35
factors that affect amniotic fluid
PROM
+ premature rupture of membranes
placental insufficiency
36
what does a more BPP indicate
- presense of normal biophysical activity indicates that CNS that controls activity is functioning well = non hypoxic
37
fetal doppler
- often performed during a BPP
- assess the fetoplacental circulation in a non invasive manner
- umbilical artery is most common vessel to doppler
38
poor doppler results detect
- IUGR = intrauterine growth restriction
- twin to twon transfusion
- fetal growth compromise due to maternal hypertension IDDM (insulin dependent diabetes mellitus)
39
normal doppler - umbilical artery
- high diastolic flow in umbilical artery
40
absent diastolic flow indicates
- difficulty for fetus to return blood to placenta or high resistance bed
- placenta insufficiency or high vascular resistance
41
reversed diastolic flow
- very worrisome
- can indicate immediate delivery is necessary depending on gestational age
- baby heart has to pump twice as hard
42
factors affecting doppler wave form
- fetal respirations
+ waveform cannot be assessed when fetus breathing
- heart rate
+ tachycardia or bradycardia
- blood viscosity (hematocrit) is severely anemic in fetuses
43
umbilical artery flow
- becomes less resistive as pregnancy advances in normal states
- as vessel gets larger as pregnancy progresses
- blood flow is less resistive
44
pulsatility index
- PI
| - used in reporting fetal doppler values
45
placenta
- not a criteria for BPP but needs to be assessed for abruption and grade
46
grade III placenta
- associated with abnormal fetal heart rates and increased risk of abruption
- normal in aging placenta in late 3rd trimester
+ if seen earlier is concerning
+ mom may be a smoker
47
sleeping babies
- in a 30 minute continuous scan a fetus may be quite inactive
- if amniotic fluid is normal this is less worrisome because the fetus is just sleeping NST performed
- ask mom when she last ate
48
timing of BPP
- observe the time you start BPP on machine clock
- assess fetal lie first
- check for fetal heart rate
- observe breathing
+ watch for 30 seconds before moving onto measurements
+ if fetus not breathing then continue on but check for breathing in-between
49
measurements taken in BPP
- BPD
- HC
- AC x 3
- FL
* fetal growth also represents placental function
50
other views in BPP
- mmode of heart
- bladder kidney
- placenta
- assessment of any abnormalities previously documneted
+ fetus with dilated kidneys = must measure again
+ fetus with dilated bowel = must measure again
51
images for parents
- DO NOT giver images to parents with measurements or callipers
- DO NOT include repot for the parents
