Fetal Biophysical Profile (BPP) Score

Fetal BPP Calculator
Fetal Breathing Movements
Gross Body Movements
Fetal Tone
Amniotic Fluid Volume
Non-Stress Test (NST)
BPP Score: 10
BPP 10 – Normal
Normal. Risk of fetal asphyxia very low. Routine follow-up.
Predicts need for urgent delivery based on sonographic and nonstress testing.

Why Use

Helps determine if emergent delivery is required.

When to Use

Use in pregnant patients, generally in the third trimester. Should be administered by users familiar with interpretation of fetal heart rate monitoring and fetal ultrasound. Indicated in pregnancies with risk of antepartum fetal demise, including maternal conditions (e.g. antiphospholipid syndrome, poorly-controlled hyperthyroidism) and pregnancy-related conditions (e.g. gestational hypertension, intrauterine growth restriction). For full list, see ACOG Practice Bulletin, Antepartum Fetal Surveillance (box 1, page 186).

Formula

Addition of the selected points: 0 points 2 points Fetal breathing <30 sec of breathing within 30 min ≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min Fetal movement <3 discrete movements ≥3 discrete body or limb movements within 30 min Fetal tone 0 extension/flexion events ≥1 episode of extremity extension and subsequent return to flexion Amniotic fluid volume* Largest single vertical pocket ≤2 cm A pocket of amniotic fluid ≥2 cm in 2 perpendicular planes (2x2 cm pocket) Nonstress test** 0 or 1 acceleration within 20–40 min ≥2 accelerations of ≥15 beats/min for ≥15 sec within 20–40 min *If largest vertical amniotic fluid pocket ≤2 cm. **May omit if all four sonographic components are normal.

Pearls / Pitfalls

Nonstress test can be omitted and presumed normal if all four sonography parameters are normal (2 points for each). Of five fetal parameters, four are acute (nonstress test, fetal breathing, fetal movement, and fetal tone) and one is chronic (amniotic fluid volume).

Critical Actions

Consult neonatology if fetal asphyxia is suspected.

More Information

Interpretation: BPP Score Interpretation Recommendation 10 Normal, non-asphyxiated fetus No fetal indication for intervention; repeat test weekly except in diabetic patients and post-term pregnancy (twice weekly) 8/10, Normal AFV Normal, non-asphyxiated fetus No fetal indication for intervention; repeat testing per protocol 8/8, NST not done Normal, non-asphyxiated fetus No fetal indication for intervention; repeat testing per protocol 8/10, Decreased AFV Chronic fetal asphyxia suspected Deliver 6 Possible fetal asphyxia If abnormal AFV, deliver. If normal AFV, delivery recommended if >36 weeks with favorable cervix or repeat test ≤6; if repeat test >6, observe and repeat per protocol 4 Probable fetal asphyxia Repeat testing same day; if ≤6, deliver 0–2 Almost certain fetal asphyxia Deliver From Manning 1980 .

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