Understand Your Biophysical Profile (BPP) Test & Score
If a pregnancy is deemed high-risk, extra checks on a baby-to-be might be in order. One of these is the biophysical profile (BPP), an ultrasound test that includes fetal heart rate monitoring.
BPPs are short and simple to conduct, typically taking half an hour or so. You’ll undergo a biophysical profile ultrasound to track your baby’s breathing and moving, her muscle tone, and how much amniotic fluid is in the womb.
The technician may also use ultrasound or a more comprehensive screening like a nonstress test to evaluate your baby’s heartbeat.
Here’s a closer look at why BPP tests are sometimes performed, when you might get one (or a similar test known as a modified biophysical profile), and how to make sense of the results.
What is a biophysical profile (BPP)?
The biophysical profile (BPP) assessment of fetal well-being is often done when other tests (like the nonstress test) require follow-up.
For instance, it might be performed if a doctor or midwife suspects that a baby isn’t getting enough oxygen or if amniotic fluid levels in the womb are too low.
When all the measurements return to normal, your baby will most likely be doing fine. However, sometimes, further testing may be needed to provide a more accurate picture of your baby’s condition.
Who is a biophysical profile for?
The doctor may order a biophysical profile if he or she suspects the mother and baby are at a higher risk of certain complications. The test can tell a mother’s care team if it’s time to induce labor.
BPPs most commonly take place in the third trimester, usually after 32 weeks, but they can be conducted any time after 24 weeks. They’re typically used for moms who:
- Are carrying twins or multiples and have certain complications
- Have conditions that raise the risk of complications, such as high blood pressure, diabetes, heart disease, or lupus
- Are two weeks past their due date
- Are experiencing reduced fetal movement
- Have too much or too little amniotic fluid
- Have Rh sensitization
How a biophysical profile is done
A BPP monitors fetal heart rate (like a nonstress test does) and is accompanied by a special ultrasound similar to a level 2 ultrasound. But rather than looking at organs and measurements, the test generally evaluates five aspects of life in utero:
- Fetal breathing: how your baby’s chest moves as she takes practice breaths in the amniotic fluid
- Fetal heart rate: the number of beats per minute of your baby’s heart
- Fetal movement: movements observed over 30 minutes, sometimes longer if the baby’s napping
- Fetal tone: the ability to flex and extend an arm or leg, measured by counting quick, jerky movements
- Volume of amniotic fluid: the amount of amniotic fluid surrounding your baby
What do BPP test results mean?
BPP test results reflect various markers, like your baby’s heart rate, breathing (which includes hiccups), movement and muscle tone, and amniotic fluid levels.
Your sonographer will assign a biophysical profile score of 0 or 2 points in each of the five categories listed above and then tally them up. Here’s what BPP score totals mean:
- A score of 8 to 10 is “reassuring,” though the test may be repeated later.
- A score of 6 may require a second BPP within 12 to 24 hours, or, depending on how far along you are in your pregnancy, your baby may be delivered.
- A score of 4 or less may mean you need additional tests or that your baby might need to be delivered right away.
Keep in mind that even if the biophysical profile score is considered “normal,” low amniotic fluid levels mean more monitoring needs to be done. In some cases, the delivery may be necessary.
Risks of a biophysical profile
Biophysical profiles are noninvasive, so undergoing one doesn’t pose any risks to you or your baby. But having the test can understandably make you feel worried or stressed. Some limited evidence suggests that extreme anxiety could potentially affect the results of the nonstress test portion of the BPP.
If the thought of a biophysical profile seems overwhelming, chat with your practitioner. You can talk through your concerns together, which can help put your mind at ease.
The modified biophysical profile
A modified biophysical profile is another type of prenatal test. It combines the nonstress test with an ultrasound to measure your amniotic fluid levels.
A modified biophysical profile is less involved but can be just as useful as a full BPP. For example, low amniotic fluid levels may indicate that the baby isn’t producing enough urine or there’s an issue with the placenta.
If your baby reacts appropriately to the nonstress test and your amniotic fluid levels are sufficient, all is likely well. However, being told you need a biophysical profile can be worrying. Just remember that the test doesn’t always mean something is seriously wrong. More importantly, the findings will help protect your baby (and you!) to ensure the healthiest possible pregnancy and the smoothest possible delivery.
