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Biophysical Profile (BPP)

Test Overview

A biophysical profile (BPP) test measures the health of your baby (fetus) during pregnancy. A BPP test may include a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. The BPP measures your baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around your baby.

A BPP is commonly done in the last trimester of pregnancy. If there is a chance that your baby may have problems during your pregnancy (high-risk pregnancy), a BPP may be done by 32 to 34 weeks or earlier. Some women with high-risk pregnancies may have a BPP test every week or twice a week in the third trimester.

Why It Is Done

A biophysical profile (BPP) test is done to:

  • Learn about and keep track of your baby's health. Special ultrasound methods are used to keep track of movement, increases in heart rate with movement (nonstress test), muscle tone, breathing rate, and the amount of amniotic fluid (amniotic fluid index) surrounding your baby. If these five areas are within a normal range, your baby is considered to be in good health.
  • Check on your baby's health if you have:

How To Prepare

You may need a full bladder for the test. If so, you will be asked to drink water or other liquids just before the test and to avoid urinating before or during the test. Usually women in the third trimester do not need to have a full bladder.

If you smoke, you will be asked to stop smoking for 2 hours before the external monitoring test because smoking decreases your baby's activity.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

Most often, a biophysical profile (BPP) is performed by your obstetrician. But it may be done by an ultrasound technologist or radiologist. A BPP can be done in your doctor's office, hospital, or clinic.

A nonstress test with electronic fetal heart monitoring and a fetal ultrasound are done as part of a biophysical profile. See a picture of fetal ultrasound and external monitoring.

Some doctors may use a modified biophysical profile, which combines a nonstress test and measurements of the amniotic fluid (amniotic fluid index).

Nonstress test

External fetal heart monitoring records your baby's heart rate while your baby is moving and not moving. It is usually done just before a fetal ultrasound.

External monitoring is done using two flat devices (sensors) held in place with elastic belts on your belly. One sensor uses reflected sound waves (ultrasound) to keep track of your baby's heart rate. The other sensor measures the duration of your contractions. The sensors are connected to a machine that records the information. Your baby's heartbeat may be heard as a beeping sound or printed out on a chart.

If your baby moves or you have a contraction, you may be asked to push a button on the machine. Your baby's heart rate is recorded and compared to the record of movement or your contractions. This test usually lasts about 30 minutes.

Fetal ultrasound

Often you do not need to remove your clothes for the ultrasound test; you can lift your shirt and push down the waistband of your skirt or pants. If you are wearing a dress, you will be given a cloth or paper covering to use during the test.

  • You may need to have a full bladder. You may be asked to drink 4 to 6 glasses of liquid, usually juice or water, about an hour before the test. A full bladder helps transmit sound waves and pushes the intestines out of the way of the uterus. This makes the ultrasound picture clearer.
    • You will not be able to urinate until the test is over. But tell the ultrasound technologist if your bladder is so full that you are in pain.
    • If an ultrasound is done during the later part of pregnancy, a full bladder may not be needed. The growing fetus will push the intestines out of the way.
  • You will lie on your back on a padded examination table. If you become short of breath or lightheaded while lying on your back, your upper body may be raised or you may be turned on your side.
  • A gel will be spread on your belly.
  • A small, handheld instrument called a transducer will be pressed against the gel on your skin and moved across your abdomen several times. You may watch the monitor to see the picture of the fetus during the test.

When the test is finished, the gel is cleaned off of your skin. You can urinate as soon as the test is done. Transabdominal ultrasound takes about 30 to 60 minutes.

Ultrasound technologists are trained to gather images of your fetus but can't tell you whether it looks normal or not. Your health professional will share this information with you after the ultrasound images have been reviewed by a radiologist or perinatologist.

How It Feels

Lying on your back (or side) during the test may be uncomfortable. During a fetal ultrasound, you may have a feeling of pressure in your bladder. The gel may feel cool when it is first applied to your stomach. You will feel a light pressure from the transducer as it passes over your abdomen.

Risks

There is very little chance of either the mother or the baby having a problem from a biophysical profile (BPP). But you may feel anxious if the ultrasound reveals a problem with your pregnancy or baby. A nonstress test may falsely show distress in a baby that is actually healthy.

Results

A biophysical profile (BPP) test measures the health of your baby (fetus) during pregnancy. The results are scores on five measurements in a 30-minute observation period.

A score of 8 to 10 points means that your baby is healthy. A score of 6 to 8 points means that you may need to be retested in 12 to 24 hours. A score of 4 or less may mean the baby is having problems. Further testing will be recommended.

Biophysical profile
Measurement Normal (2 points) Abnormal (0 points)
Nonstress test

2 or more heart rate increases of 15 beats per minute or more are seen with movement.

Only 1 heart rate increase is seen, or the heart rate does not increase by more than 15 beats with movement.
Breathing movement

1 or more breathing movements last at least 30 seconds.

Breathing movement lasts less than 30 seconds, or no breathing is seen.
Body movement

3 or more movements of the arms, legs, or body

Less than 3 movements of the arms, legs, or body
Muscle tone

Arms and legs are usually flexed and the head rests on the chest. 1 or more extensions and return to flexion are seen, such as the opening and closing of a hand.

The fetus extends slowly and only returns partway to a normal position.

The fetus extends but does not return to a normal position.

The arms, legs, or spine are extended, or a hand is open.
Amniotic fluid volume (amniotic fluid index)

At least one pocket of amniotic fluid of at least 2 cm (0.8 in.) is seen in the uterine cavity.

Not enough amniotic fluid is seen in the uterine cavity.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • The baby is in a position that makes an ultrasound difficult.
  • Being unable to lie still throughout the procedure, which can cause the picture of your baby to be unclear.
  • Being overweight, which may make it difficult to correctly position the external monitoring device.
  • An infection in either you or your baby.
  • Low (hypoglycemia) or high (hyperglycemia) blood sugar levels.
  • Taking medicine, such as magnesium sulfate.
  • Steroids given to help the baby's lungs mature.
  • Using alcohol or illegal drugs, such as cocaine.
  • In rare cases, stool (feces) or air in the intestines or rectum interfering with the fetal ultrasound.

What To Think About

  • A biophysical profile includes a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. For more information, see the topics Electronic Fetal Heart Monitoring and Fetal Ultrasound.
  • Additional tests, such as a contraction stress test, may be recommended if your results are not normal. For more information, see the topic Contraction Stress Test.
  • If there is a chance that you or your baby may have problems during your pregnancy, you may have a biophysical profile test every week or twice a week during the last 12 weeks of your pregnancy. Your chances of having problems may be higher if you have:
  • A biophysical profile may be done after an injury, such as a car crash or fall. Your doctor may recommend additional BPP tests during the rest of your pregnancy.

Other Places To Get Help

Organization

American Congress of Obstetricians and Gynecologists (ACOG)
409 12th Street SW
P.O. Box 96920
Washington, DC  20090-6920
Phone: (202) 638-5577
Email: resources@acog.org
Web Address: www.acog.org
 

American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.

References

Other Works Consulted

  • American College of Obstetricians and Gynecologists (1999, reaffirmed 2009). Antepartum fetal surveillance. ACOG Practice Bulletin No. 9. Obstetrics and Gynecology, 94(4): 1–11.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised June 21, 2010

Last Revised: June 21, 2010

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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