From the Guidelines
Induction of labor is typically recommended when a biophysical profile (BPP) score is 6/10, especially if the patient is at or beyond 37 weeks of gestation. The decision should be individualized based on gestational age, maternal conditions, and fetal status. For pregnancies at term (≥37 weeks), prompt delivery is generally advised due to the increased risk of adverse outcomes with a suboptimal BPP score, as indicated by the American College of Radiology 1.
Key Considerations
- For pregnancies between 34-36 weeks, delivery may be recommended after antenatal corticosteroids are administered to enhance fetal lung maturity.
- For pregnancies less than 34 weeks, management depends on the specific components of the BPP that are abnormal, with consideration for repeating the BPP within 24 hours while providing close monitoring.
- The rationale behind this approach is that a score of 6/10 indicates moderate fetal compromise, suggesting potential placental insufficiency or fetal distress.
- Induction typically involves cervical ripening with prostaglandins (misoprostol or dinoprostone) if the cervix is unfavorable, followed by oxytocin administration, as suggested by guidelines from the American College of Obstetricians and Gynecologists 1.
- Continuous fetal monitoring during induction is essential to detect any signs of fetal intolerance to labor.
Management Approach
- The use of misoprostol for cervical ripening and induction of labor is supported by evidence, with lower dosages (25 µg every three to six hours) being effective, although higher dosages may be used in specific situations with caution due to the risk of uterine hyperstimulation 1.
- The choice between misoprostol and dinoprostone should consider factors such as cost, stability of the compound, and the need for refrigeration, with misoprostol being more cost-effective and stable at room temperature 1.
From the Research
Induction of Labor with Biophysical Profile Score of 6/10
- The biophysical profile score is a measure of fetal well-being, with a score of 6/10 indicating some compromise in fetal health 2.
- According to a study published in 2001, a biophysical profile score of less than 6/10 is associated with an increased risk of fetal compromise and may require closer monitoring and potential intervention 2.
- Induction of labor may be recommended in cases where the biophysical profile score is 6/10, especially if there are other indications of fetal distress or compromise.
- Misoprostol has been shown to be a safe and effective agent for induction of labor in various studies, including those with a biophysical profile score of 6/10 3, 4, 5, 6.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that induction of labor be considered in cases where the biophysical profile score is 6/10 or less, especially if there are other indications of fetal distress or compromise.
Misoprostol for Induction of Labor
- Misoprostol is a prostaglandin E1 analog that can be used for induction of labor, and has been shown to be effective in various studies 3, 4, 5, 6.
- The recommended dose of misoprostol for induction of labor is 25 mcg vaginally every 4 to 6 hours, as needed 3.
- Misoprostol has been shown to be safe and effective for induction of labor in women with a biophysical profile score of 6/10, with no significant increase in adverse maternal or fetal outcomes 4, 6.
Timing of Induction of Labor
- The timing of induction of labor will depend on various factors, including the biophysical profile score, gestational age, and presence of other indications of fetal distress or compromise.
- According to a study published in 2001, Doppler evaluation of the umbilical artery, middle cerebral artery, and ductus venosus can help identify fetuses at risk of compromise and guide the timing of induction of labor 2.
- Induction of labor should be considered in cases where the biophysical profile score is 6/10 or less, especially if there are other indications of fetal distress or compromise.