Biophysical profile (BPP) score : 0 or 2 points for 4 parameters in 30 min; numbers added for BPP score: 0, 2, 4, 6, 8 out of 8; can finish early if 8/8 scored < 30 min

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  Breathing (thoracic movement): 2 points if

  
  
  
  
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    ≥ 1 episode 30 seconds continuous breathing

    
    
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    Hiccups are acceptable

  
  
  
  
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  Gross body movement: 2 points if

  
  
  
  
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    ≥ 3 discrete movements (trunk roll, spine flexion/extension, gross limb movement)

  
  
  
  
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  Tone: 2 points if

  
  
  
  
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    ≥ 1 episode active extension then flexion of 1 limb

    
    
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    Hand opening and closing is acceptable

  
  
  
  
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  Amniotic fluid: 2 points if

  
  
  
  
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    ≥ 1 pocket measures ≥ 2 cm vertical and ≥ 1 cm width

  
  

Doppler: Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV)

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  Normal UA and DV with ↑ diastolic flow

  
  
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  Abnormal UA and DV with ↓ or reversed diastolic flow

  
  
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  Normal MCA is high resistant (↓ diastolic flow)

  
  
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  Abnormal MCA has ↑ diastolic flow (“brain-sparing”)

Fetal growth assessment: Estimated fetal weight < 10th percentile considered growth restriction

Well-being assessment goal: Identify fetuses at risk for in utero death (from hypoxia/asphyxia) → deliver early

Conditions associated with fetal hypoxia: Hypertension, diabetes, collagen-vascular disease, postdates, infection

BPP < 6/8 is abnormal (0 for fluid is most worrisome)

Fetal monitoring non-stress test is additive

Never give 1 point for partial credit in BPP

Document breathing with video/cine clips

Pregnancy can have oligohydramnios and score 2 for fluid

Turn on color Doppler before measuring fluid pocket

Do not let patient leave unit if BPP is < 6/8