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Obstetrics & Gynecology 2003;102:471-476
© 2003 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Is the Intrapartum Biophysical Profile Useful?

So Young Kim, MD, Meena Khandelwal, MD, John P. Gaughan, PhD, Mehmet H. Agar, MD and E. Albert Reece, MD, PhD

From the Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, and Department of Internal Medicine and Biostatistics, Temple University School of Medicine, Philadelphia, Pennsylvania; and University of Arkansas Medical School and College of Medicine, Little Rock, Arkansas.

Address reprint requests to: Meena Khandelwal, MD, Temple University School of Medicine, Department of Obstetrics and Gynecology and Internal Medicine, 3401 North Broad Street, Philadelphia, PA 19140; E-mail: meenak{at}temple.edu.

OBJECTIVE: To assess the role of biophysical profile (BPP) during normal labor. The secondary goal was to assess the effect of oxytocics, regional anesthesia, and ruptured membranes on fetal behavior during labor.

METHODS: The BPP (according to the Manning criteria) was performed prospectively in 100 normal, singleton pregnancies in active labor. To evaluate its role in the prediction of cesarean delivery and admission to the neonatal intensive care unit (NICU), statistical analysis included {chi}2 and Fisher exact tests for frequency analyses and t tests for comparisons of continuous data.

RESULTS: At the mean cervical dilatation of 5.2 ± 1.4 cm, 73 women had a BPP score of at least 8/10, 16 had 6/10, six had 4/10, and five had 2/10. The BPP was not influenced by use of oxytocics, prostaglandins, or epidural anesthesia. Fetal breathing (95% versus 71%; P = .002) and gross fetal movements (98% versus 84%; P = .04) decreased with rupture of amniotic membranes (Table 2). A BPP score of 6/10 or less in labor was associated with a relative risk (RR) for cesarean delivery of 8.00 (95% confidence interval [CI] 2.4, 26.5). Cessation of any ultrasound component of BPP significantly increased the risk of cesarean delivery and admission to the (NICU) (RR =29; 95% CI 2.73, 308.66). In the multivariable analysis, however, fetal movements and amniotic fluid volume were most important in predicting the need for cesarean delivery.


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  		Table 2. Effect of Labor, Cervical Dilatation, Epidural Anesthesia, Meconium Staining, and Membrane Rupture on the Individual Components of the Biophysical Profile
 
CONCLUSION: Fetal heart rate monitoring alone did not predict the need for cesarean delivery or neonatal outcome, whereas the BPP did. Biophysical profile could prove to be a clinically useful adjunctive tool in the assessment of fetal well-being in labor.




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 Obstet GynecolHome page
C. A. Krantz, L. E. T. Shaffer, S. Y. Kim, M. Khandelwal, J. P. Gaughan, M. Agar, and E. A. Reece
Is the Intrapartum Biophysical Profile Useful?
Obstet. Gynecol., February 1, 2004; 103(2): 400 - 400.
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