Def|n|t|on

1he feLal blophyslcal proflle (8) ls a LesL performed Lo measure feLal wellbelng lL uses ulLrasonography Lo measure feLal breaLhlng feLal movemenL feLal
Lone and amnloLlc fluld volume A nonsLress LesL ls done Lo assess feLal heart raLe Lach of Lhese flve varlables ls glven a score of zero or Lwo for a poLenLlal
LoLal score of 10 A 8 ls generally performed afLer 32 weeks of gesLaLlon
urpose
1he purpose of Lhe 8 ls Lo assess feLal wellbelng lL ls a Lool used near or aL Lerm by cllnlclans Lo assess Lhe poLenLlal rlsk of feLal compromlse or demlse due
Lo feLal hypoxla or acldosls lnLervenLlon such as maLernal hosplLallzaLlon or dellvery may follow a 8 score of four or below
A blophyslcal proflle (8) LesL ls done Lo
O earn abouL and keep Lrack of your babys healLh Speclal ulLrasound meLhods are used Lo keep Lrack of movemenL lncreases ln hearL raLe wlLh
movemenL (nonsLress LesL) muscle Lone breaLhlng raLe and Lhe amounL of amnloLlc fluld (amnloLlc fluld lndex) surroundlng your baby lf Lhese flve
areas are wlLhln a normal range your baby ls consldered Lo be ln good healLh
O heck on your babys healLh lf you have
4 yperLhyroldlsm
4 8leedlng problems
4 upus
4 hronlc kldney dlsease
4 1ype 1 dlabeLes or gesLaLlonal dlabeLes
4 lgh blood pressure (hyperLenslon)
4 reeclampsla
4 A small amounL of amnloLlc fluld (ollgohydramnlos) or Loo much amnloLlc fluld (polyhydramnlos)
4 A mulLlple pregnancy (such as Lwlns or LrlpleLs)
4 A pregnancy LhaL has gone pasL your due daLe beLween 40 and 42 week
recaut|ons
A rellable 8 score necesslLaLes LhaL a wellLralned ulLrasonographer perform Lhe LesL owever feLal parameLers are recorded over a 30mlnuLe Llme perlod
wlLh an addlLlonal 30 mlnuLes for Lhe nonsLress LesL (nS1) componenL lnformaLlon on a very acLlve feLus ls obLalned lnconslderably less Llme 1he compleLe
8 can Lherefore be a Llmeconsumlng LesL 1he nS1 records Lhe relaLlonshlp of feLal hearL raLe Lo feLal movemenL lL ls assoclaLed however wlLh a false
poslLlve raLe as hlgh as 80 and averaglng abouL 30
Descr|pt|on
1he 8 ls a LesL scorlng flve feLal vlLal slgn varlables feLal hearL raLe feLal breaLhlng feLal movemenL feLal Lone and amnloLlc fluld volume An ulLrasound ls
used Lo vlsuallze Lhe feLus Lo measure Lhese varlables 1he feLal hearL raLe ls assessed Lhrough an nS1 Lach parameLer ls glven a score of Lwo or zero based on
speclflc crlLerla 1he LoLal poLenLlal score ls a 10 1he 8 may be ordered followlng a nonreacLlve nS1 afLer a susplclous oxyLocln challenge/conLracLlon stress
test (S1) or afLer Lerm especlally lf Lhere ls concern abouL low amnloLlc fluld volume (ollgohydramnlos) 1he flrsL researchers Lo reporL Lhe resulLs of scorlng
Lhese feLal blophyslcal varlables as a group were Mannlng and colleagues ln 1980
leLal breaLhlng (l8) ls measured by waLchlng for movemenL of Lhe feLal Lhorax and dlaphragm 1hls ls Lo assure breaLhlng and noL [usL chesL wall movemenL A
score of Lwo ls glven lf aL leasL one occurrence of l8 lasLlng aL leasL 30 seconds durlng Lhe 30mlnuLe LesL ls noLed A score of zero ls glven lf no l8 ls seen or lf
Lhe l8 lasLed less Lhan 30 seconds
leLal movemenL ls deflned by gross arm leg or body acLlvlLy A score of Lwo ls glven lf Lhere are aL leasL Lhree separaLe llmb/body movemenLs durlng Lhe 30
mlnuLe LesL A score of 0 ls glven lf Lhere are Lwo or fewer llmb/body movemenLs durlng Lhe LesL laclal movemenL ls noL scored
leLal Lone ls deflned by acLlve exLenslon and flexlon of Lhe feLal llmbs Lrunk or hand or lf Lhe hand remalns ln a flexed poslLlon durlng Lhe enLlre 30mlnuLe
LesL A score of Lwo ls glven lf Lhe hand and flngers are seen Lo fully exLend and flex lnLo a flsL A score of zero ls glven lf no such movemenL ls recorded or wlLh
slow or parLlal flexlon or exLenslon
AmnloLlc fluld volume ls esLlmaLed for sufflclency Slnce feLal anaLomlc sLrucLures do noL allow full vlsuallzaLlon of all Lhe amnloLlc fluld lL ls esLlmaLed by
measurlng n of fluld from 039 Lo 078 ln (1 Lo 2 cm) ln helghL on ulLrasound A score of Lwo ls glven lf aL leasL one pockeL of fluld measures 078 ln (2 cm)
or more ln helghL A score of zero ls glven when no such pockeLs can be measured normal amnloLlc fluld volume peaks aL abouL 730 ml aL 32 weeks gesLaLlon
sLays sLable unLll Lerm aL 40 weeks and Lhen decllnes Lo abouL 400 ml by 42 weeks Lxcesslve amnloLlc fluld amounLs (hydramnlos) such as mlghL be seen ln
dlabeLlc moLhers may be as hlgh as 1700 Lo 1900 ml Cllgohydramnlos ls deflned by abouL 300 ml of fluld volume 1he amnloLlc fluld ls produced as Lhe feLus
urlnaLes and Lhrough lung secreLlons 1he volume ls conLrolled by feLal swallowlng and by reabsorpLlon Lhrough Lhe membranes 1he amnloLlc fluld lndex (All)
ls also used Lo deLermlne sufflclency of amnloLlc fluld ln Lhls meLhod Lhe largesL verLlcal column of fluld ln each of Lhe four uLerlne quadranLs ls measured
8ecause of Lhe role of Lhe feLus ln Lhe producLlon and conLrol of amnloLlc fluld lL ls one varlable ln feLal wellbelng assessmenL
leLal hearL raLe (l) varlablllLy ls measured durlng a nS1 1he feLal hearL raLe ls normally varlable ln naLure AcceleraLlons or lncreases ln l are usually
seen ln response Lo feLal movemenLs and are Lherefore reassurlng A score of Lwo ls glven for Lwo or more acceleraLlons of aL leasL 13 beaLs per mlnuLe LhaL
lasL aL leasL 13 seconds each durlng a 30mlnuLe perlod A score of 0 ls glven lf fewer Lhan Lwo acceleraLlons are seen wlLhln 30 mlnuLes
reparat|on
8ecause Lhe 8 ls done durlng Lhe Lhlrd LrlmesLer of pregnancy Lhere ls sufflclenL amnloLlc fluld Lo provlde conLrasL Lo clearly vlsuallze Lhe feLus no
preparaLlon ls usually requlred before Lhe LesL ls performed 1he moLher may be asked Lo have a snack prlor Lo Lhe LesL Lo encourage a more acLlve feLus
8ecause Lhe moLhers abdomen ls exposed curLalns or a closed door should provlde prlvacy A comforLable room alr LemperaLure and Lhe warmlng of Lhe
Lransducer gel can asslsL ln puLLlng Lhe moLher aL ease 1he moLher should be asked lf she wanLs her parLner or supporL person wlLh her durlng Lhe LesL A
Lowel or cloLh should cover Lhe moLhers cloLhlng Lo avold lLs geLLlng weL from Lhe Lransducer gel
?ou may need a full bladder for Lhe LesL lf so you wlll be asked Lo drlnk waLer or oLher llqulds [usL before Lhe LesL and Lo avold urlnaLlng before or durlng Lhe
LesL usually women ln Lhe Lhlrd LrlmesLer do noL need Lo have a full bladderlf you smoke you wlll be asked Lo sLop smoklng for 2 hours before Lhe exLernal
monlLorlng LesL because smoklng decreases your babys acLlvlLy
ftercare
MosL ofLen a blophyslcal proflle (8) ls performed by your obsLeLrlclan 8uL lL may be done by an ulLrasound LechnologlsL or radlologlsL A 8 can be done ln
your docLors offlce hosplLal or cllnlc
A nonsLress LesL wlLh elecLronlc feLal hearL monlLorlng and a feLal ulLrasound are done as parL of a blophyslcal proflle Some docLors may use a modlfled
blophyslcal proflle whlch comblnes a nonsLress LesL and measuremenLs of Lhe amnloLlc fluld
ylng on your back (or slde) durlng Lhe LesL may be uncomforLable uurlng a feLal ulLrasound you may have a feellng of pressure ln your bladder 1he gel may
feel cool when lL ls flrsL applled Lo your sLomach ?ou wlll feel a llghL pressure from Lhe Lransducer as lL passes over your abdomen
Ieta| u|trasound
CfLen you do noL need Lo remove your cloLhes for Lhe ulLrasound LesL you can llfL your shlrL and push down Lhe walsLband of your sklrL or panLs lf you are
wearlng a dress you wlll be glven a cloLh or paper coverlng Lo use durlng Lhe LesL
O ?ou may need Lo have a full bladder ?ou may be asked Lo drlnk 4 Lo 6 glasses of llquld usually [ulce or waLer abouL an hour before Lhe LesL A full
bladder helps LransmlL sound waves and pushes Lhe lnLesLlnes ouL of Lhe way of Lhe uLerus 1hls makes Lhe ulLrasound plcLure clearer
4 ?ou wlll noL be able Lo urlnaLe unLll Lhe LesL ls over 8uL Lell Lhe ulLrasound LechnologlsL lf your bladder ls so full LhaL you are ln paln
4 lf an ulLrasound ls done durlng Lhe laLer parL of pregnancy a full bladder may noL be needed 1he growlng feLus wlll push Lhe lnLesLlnes ouL of
Lhe way
O ?ou wlll lle on your back on a padded examlnaLlon Lable lf you become shorL of breaLh or llghLheaded whlle lylng on your back your upper body may
be ralsed or you may be Lurned on your slde
O A gel wlll be spread on your belly
O A small handheld lnsLrumenL called a Lransducer wlll be pressed agalnsL Lhe gel on your skln and moved across your abdomen several Llmes ?ou may
waLch Lhe monlLor Lo see Lhe plcLure of Lhe feLus durlng Lhe LesL
When Lhe LesL ls flnlshed Lhe gel ls cleaned off of your skln ?ou can urlnaLe as soon as Lhe LesL ls done 1ransabdomlnal ulLrasound Lakes abouL 30 Lo 60
mlnuLes
ulLrasound LechnologlsLs are Lralned Lo gaLher lmages of your feLus buL canL Lell you wheLher lL looks normal or noL ?our healLh professlonal wlll share Lhls
lnformaLlon wlLh you afLer Lhe ulLrasound lmages have been revlewed by a radlologlsL or perlnaLologlsL
omp||cat|ons
8ecause Lhe LesL ls nonlnvaslve ln naLure compllcaLlons from Lhe LesL lLself are unexpecLed A nonreassurlng LesL may be repeaLed four Lo 24 hours laLer for
comparlson LfforLs should be made Lo assess for false negaLlves or false poslLlves A low 8 score may be followed by lnLervenLlons wlLh Lhelr own poLenLlal
compllcaLlons
kesu|ts
A score of elghL or Len ouL of Len provldes a reassurlng 8 score lf Lhe score ls elghL wlLh a decrease ln amnloLlc fluld volume dellvery may be lndlcaLed wlLh
feLal maLurlLy A score of slx arouses susplclons of chronlc feLal hypoxla A repeaL LesL wlLhln four Lo slx hours may be ordered uellvery may be lndlcaLed lf
Lhere ls a reducLlon ln Lhe amnloLlc fluld volume A score of four ls susplclous of chronlc feLal hypoxla A feLal lung maLurlLy LesL may be done Lo assess
readlness for dellvery uellvery ls lndlcaLed lf a repeaL 8 afLer 24 hours conflrms a score of four or below A score of zero Lo Lwo ellclLs a sLrong susplclon of
chronlc feLal hypoxla 1he 8 LesLlng perlod may conLlnue for Lwo hours lnsLead of Lhe usual 30 mlnuLes lf Lhe Lwohour score ls four or below dellvery ls
lndlcaLed lf Lhe feLus has a good chance aL exLrauLerlne survlval
What 1o 1h|nk out
O A blophyslcal proflle lncludes a nonsLress LesL wlLh elecLronlc feLal hearL monlLorlng and a feLal ulLrasound lor more lnformaLlon see Lhe Loplcs
LlecLronlc leLal earL MonlLorlng and leLal ulLrasound
O AddlLlonal LesLs such as a conLracLlon sLress LesL may be recommended lf your resulLs are noL normal lor more lnformaLlon see Lhe Loplc
onLracLlon SLress 1esL
O lf Lhere ls a chance LhaL you or your baby may have problems durlng your pregnancy you may have a blophyslcal proflle LesL every week or Lwlce a
week durlng Lhe lasL 12 weeks of your pregnancy ?our chances of havlng problems may be hlgher lf you have
4 erLaln medlcal condlLlons such as hlgh blood pressure kldney dlsease dlabeLes preeclampsla or auLolmmune dlseases
4 A hlsLory of a sLlllblrLh or preeclampsla
4 A hlsLory of h lncompaLlblllLy
4 A hlsLory of early labor premaLure rupLure of membranes (CM) or placenLa problems
4 A baby who seems small for Lhe lengLh of Lhe pregnancy or ls noL growlng (lnLrauLerlne growLh reLardaLlon or resLrlcLlon)

1kMS

Iar|a|||ty1he feLal hearL raLe ls expecLed Lo change or be varlable ln naLure Whlle Lhe adulL hearL raLe remalns sLable excepL wlLh exerLlon Lhe raLe of Lhe
feLal hearL conLlnually moves up and down A flaL feLal hearL raLe ls consldered an omlnous slgn

nea|th care team ro|es
a Lralned ulLrasonographer 1he nS1 may be performed by a nurse or a radlology Lechnlclan

1able 1 rlLerla for odlng leLal 8lophyslcal varlables as normal or Abnormal
8|ophys|ca|



Iar|a|e


Norma|



(Score 2)


norma|



(Score 0)


leLal breaLhlng
movemenLs
1 or more eplsodes of 20 s wlLhln 30 mln AbsenL or no eplsode of 20 s wlLhln 30 mln
Cross body
movemenLs
2 or more dlscreLe body/ llmb movemenLs wlLhln 30 mln (eplsodes of
acLlve conLlnuous movemenL consldered as a slngle movemenL)
2 eplsodes of body/llmb movemenLs wlLhln 30 mln
leLal Lone 1 or more eplsodes of acLlve exLenslon wlLh reLurn Lo flexlon of feLal
llmb(s) or Lrunk (openlng and closlng of hand consldered normal Lone)
Slow exLenslon wlLh reLurn Lo parLlal flexlon movemenL of llmb ln
full exLenslon absenL feLal movemenL or parLlally open feLal hand
eacLlve l 2 or more eplsodes of acceleraLlon of 13 bpm* and of 13 s
assoclaLed wlLh feLal movemenL wlLhln 20 mln
1 or more eplsodes of acceleraLlon of feLal hearL raLe or
acceleraLlon of 13 bpm wlLhln 20 mln
CuallLaLlve Alv 1 or more pockeLs of fluld measurlng 2 cm ln verLlcal axls LlLher no pockeLs or largesL pockeL 2 cm ln verLlcal axls
*8eaLs per mlnuLe

1able 2 MaLuraLlon of enLral nervous SysLem egulaLory enLers
ct|v|ty
Gestat|ona| ge



of Maturat|on



(wk)


Cross body movemenLs 6
8reaLhlng movemenLs 1214
l acceleraLlons resulLlng from feLal movemenL 1820
Sleepwake cycles 1822
lnLegraLed behavloral paLLerns 28

8lophyslcal roflle
ct|v|ty Ink 1one Gross Ieta| II



cce|erat|ons





Movement





8reath|ng


leLal sleep ; ; ; ;
Larly gesLaLlonal age ( 33 wk) ; ;
aLe gesLaLlonal age (42 wk) ; ; ; ;
MaLernal glucose lngesLlon ;
MaLernal alcohol lngesLlon ;/ ;/
MaLernal magneslum admlnlsLraLlon ; ;
ArLlflclal rupLure of membranes ; ;
remaLure rupLure of membranes ;
abor ;
key A blank box lndlcaLes LhaL no daLa are avallable for LhaL
parameLer
WhaL AffecLs Lhe 1esL
easons you may noL be able Lo have Lhe LesL or why Lhe resulLs may noL be helpful lnclude
- 1he baby ls ln a poslLlon LhaL makes an ulLrasound dlfflculL
- 8elng unable Lo lle sLlll LhroughouL Lhe procedure whlch can cause Lhe plcLure of your baby Lo be unclear
- 8elng overwelghL whlch may make lL dlfflculL Lo correcLly poslLlon Lhe exLernal monlLorlng devlce
- An lnfecLlon ln elLher you or your baby
- ow (hypoglycemla) or hlgh (hyperglycemla) blood sugar levels
- 1aklng medlclne such as magneslum sulfaLe
- SLerolds glven Lo help Lhe babys lungs maLure
- uslng alcohol or lllegal drugs such as cocalne
- ln rare cases sLool (feces) or alr ln Lhe lnLesLlnes or recLum lnLerferlng wlLh Lhe feLal ulLrasound