From the Guidelines
The biophysical profile score for the fetus is 4, indicating moderate fetal compromise and warranting prompt delivery, especially at 39 weeks gestation. The biophysical profile (BPP) assesses five components, each worth 2 points: fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and nonstress test reactivity. In this case, the fetus has normal tone (2 points) and normal fetal movement (2 points), but abnormal amniotic fluid volume (0 points), abnormal fetal breathing (0 points), and a nonreactive nonstress test (0 points) 1. Adding these values together (2+2+0+0+0) gives a total BPP score of 4. This score is based on the criteria that each component of the BPP meeting the defined criteria receives a score of 2, for a composite score out of 8, and if the nonstress test is included, it is assigned a score of 2 if reactive, for a combined score for the BPP out of 10 1.
The components of the BPP are:
- Fetal breathing movements: abnormal (0 points)
- Gross body movements: normal (2 points)
- Fetal tone: normal (2 points)
- Amniotic fluid volume: abnormal (0 points)
- Nonstress test reactivity: nonreactive (0 points)
According to the American College of Radiology, a composite score of 8 or 10 is normal, 6 is equivocal, and 4 or less is abnormal 1. Therefore, a score of 4 indicates moderate fetal compromise. The decreased fetal movement reported, combined with the nonreactive nonstress test and abnormal components of the BPP, suggests potential fetal distress that requires immediate attention to prevent adverse outcomes. Prompt delivery is typically recommended in such cases, especially at 39 weeks gestation, to ensure the best possible outcome for the fetus 1.
From the Research
Biophysical Profile Score Calculation
The biophysical profile score is calculated based on five variables: non-stress test, fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume. Each variable is assigned a score of 0 or 2, with a maximum total score of 10.
Variable Scores
- Non-stress test: 0 (nonreactive)
- Fetal breathing movements: 0 (abnormal)
- Fetal movements: 2 (normal)
- Fetal tone: 2 (normal)
- Amniotic fluid volume: 0 (abnormal)
Total Biophysical Profile Score
Based on the given information, the total biophysical profile score would be: 2 (fetal movements) + 2 (fetal tone) + 0 (non-stress test) + 0 (fetal breathing movements) + 0 (amniotic fluid volume) = 4.
Interpretation of Biophysical Profile Score
A biophysical profile score of 4 is considered abnormal, as seen in studies 2, 3. The predictive accuracy of the biophysical profile score for abnormal perinatal outcomes is higher with certain variable combinations, such as nonreactive non-stress test and absent fetal breathing movement 3.
Gestational Age Considerations
The biophysical profile score should be interpreted in relation to gestational age, as some variables are more likely to be abnormal at certain gestational ages 4. However, in this case, the fetus is at 39 weeks of gestation, which is near term.
Clinical Implications
The abnormal biophysical profile score, in this case, a score of 4, indicates a higher risk of abnormal perinatal outcomes, and further evaluation and management may be necessary 2, 3.