Biophysical and biophysical well being of fetus

1. Guide & Evaluated by:
Mrs. Amirtha Gowri.,M.Sc(N)
Mrs.Vijayalaxmi.,M.Sc(N)
Faculty of Nursing
Presented by:
S.Anbuselvi
1st
year M.Sc(N)

2. Biophysical Principles
 Biophysical profile is a screening test for utero-
placental insufficiency.
 Fetal biophysical activities are initiated
modulated and regulated through fetal nervous
system

3. Biophysical tests
 Fetal movement count
 Cardiotocography
 Non-stress test
 Fetal biophysical profile
 Doppler ultrasound
 Vibro acoustic stimulation test
 Contraction stress test(CST)

4. Fetal Movement Count
 Two method
Cardif “count 10” formula:
○ The fetal movement starting at 9.A.M, the counting
comes to an end as soon as 10 movements.
○ Lessthan 10 movements- in 12hrs on 2 successive
days
○ No movements is perceived even after 12hrs in a
single day.

5. Daily Fetal Movement Count(DFMC)
 Three counts each of one hour duration(morning, noon
and evening) are recommended.
 The total counts are multiplied by 4 gives daily (12
hours).
 Kick – is lessthan 3 in each hour-indicates fetal
compromise.
 The count should be performed starting daily at 28
weeks of pregnancy.
 Maternal hypoglycaemia- associated with increased
fetal movement.
 Maternal perception of fetal movements may be
reduced with fetal sleep.

6. Non-Stress test
 Continuous electronic monitoring of the fetal heart rate along with
recording of fetal movement
 Fetal heart rate acceleration with fetal movements – indicates
healthy fetus.
 Reactive- two or more acceleration morethan 15 beats per minute
above the baseline and longer than 15 seconds- 20 minutes
observation
 Non-Reactive- absence of any fetal reactivity.
 The test to be started after 30 weeks twice weekly.
 Vibro Acoustic stimulation- assess the fetal sleep starts from quiet
to active sleep indicates a reactive fetus- harmless.

7. Fetal Biophysical Profile(BPP)
 Consists of NST and ultrasonographically determined amniotic fluid
index. BIO PHYSICAL SCORING
Parameters Minimal Normal Criteria Score
 Non stress test
 Fetal Breating movment
 Gross body Movment
 Fetal Muscle Tone
 Amniotic Fluid
INTERPRETATION
No fetal Asphyxia
 Chronic Asphyxia
 Chronic Asphyxia
 Certain Asphyxia
Reactive Pattern
Lepisode lasting> 30 Sec
3 discrete body / Limb movments
1 episode of extension(Limb/
trunk)with return of flexion
1 Pocket Measuring 2cm in 2
perpendicular planes
MANAGEMENT
At weekly intervals
>36 weeks deliver
<30 weeks repeat testing in 4-6 Hrs
≤ 120 min persistent score ≤ 4
2
2
2
2
2
8-10
6
4
2

8. Fetal Cardiotocography(CTG)
 Two method
External – continuous tracing of FHR
Internal – fetal ECG tracing is made by applying a
spiral pointed scalp electrode to the fetal scalp after
rupturing the membrane.
○ Intra uterine pressure could be simultaneously
measured by passing a catheter inside the uterine cavity.
○ Advantages – can detect hypoxia
○ Drawbacks – trained personnel required .,instruments
are expensive

9. Interpretation of an intra partumInterpretation of an intra partum
cardio tocographcardio tocograph
Character Normal Suspicious Abnormal
Baseline FHR
Baseline
variability
Acceleration
Deceleration
110-150 BPM
10-25 bpm
2 in 20 min
None or early
<110 bpm or
>150 bpm
<5 bpm for
>40min
None in 40 min
Variable <60
bpm for <60 sec
>150 bpm or <110 bpm with
decleration or variability < 5 bpm.
<5 bpm for >90 min or Sinusoidal
pattern
None in 40 min
Variable >60 bpm for >60 sec or
repetitive late deceleration or
bradycardia > 3 min

10. Contraction Stress Test(CST)
 Asses fetal well-being during pregnancy where there is
alteration in FHR in response to uterine contractions.
 Indications:
Intrauterine growth restriction
Post maturity
Procedure:
 Oxytocin infusion is started –initial rate of infusion 1ml
stepped up at the intervals of 20 minutes.
 Using hand to palpate the hardening of the uterus
during contracting auscultation of FHR/1 minute – 1 to
2 hours. To perform the test.

11. Interpretation of CST
 Positive – persistent late deceleration of FHR
 Negative – no late deceleration
 Suspicious – inconsistent
 Unsatisfactory – poor quality of recording.
 Hyperstimulation – deceleration of FHR with uterine
contraction lasting >90 seconds.
 Nipple stimulation test – rubbing the nipple through
her clothes for 10 minutes and it takes less time
compared to CST.

12. Ultrasonography
 The audible range of frequency greater than 2MHz
(cycles per second).
 Sonar- “sound navigation and ranging”
 Introduced – Ian Donald – Glasgow- 1958.
 Methods
Through abdominal transducers – 3 to 5 MHz.
Vaginal transducers – 5 to 7 MHz.
B mode – brightness mode (2-D) images are obtained.
M mode – to study the moving organs, a wave pattern in
the presence of motion eg. Fetal heart.

13. I.Trimester.
 Intrauterine Gastational Sac:
Yolk sac- 7000 mIU/ml
Embryo – 11000mIU/ml
Gestational sac – eccentric in position within the
endometrium of fundus
Double decidua sign – decidua and the chorion which
appears as the two distinct layers of the wall of the
gestation sac.
GS should increased by 1.1mm in diameter per day

14. Fetal anatomy and viability
Gestational age and fetal structures identified by Transvaginal
Sonography (TVS)
Menstrual age(weeks) Fetal Structures
4
5
6
7
8
9
Choriodecidual thickness, choronic
sac.
Gestation sac. Yolk sac
Fetal pole, cardiac activity
Lower limb buds, midgut
herination(Physiological)
Upper limb buds, stomach
Spine, choroid plexus.

15. Nuchal translucency
 Increased fetal nuchal skin thickness >3mm by TVS –
strong marker for chromosomal anomalies.(Tri –
21,18,13)
 Gastational age.
The four methods of fetal age estimation
○ Determination of gestational sac dimension(at about 8 weeks)
○ Measurement of crown-rump length(7 to 12 weeks)
○ Measurement of biparietal diameter (after 12 weeks)
○ Measurement of femur length (12 weeks)
○ The average increase in the biparietal diameter beyond 34 weeks is
1.7mm per week
○ When the HC/AC ratio is elevated (>1.0) after 34 weeks IUGR is
Suspected.
○ A measurement of biparietal diameter of 9.8cm indicates maturity.

16. Mid Trimester
 Fetal Growth-is calculated on the basis of an
accurate gestational age and is expressed in
percentiles – normal fetal weight should be between
the 10th
and 90th
percentiles weight less than 10th
percentile is considered small for gestational
age(SGA) whereas more than 90th
percentile is large
for gestational age.
 Indication
Fetal viability, number, gestational age
Aminiotic fluid volume
Placental location and maturity

17. Neural tube defects(NTD)
 Cranial abnormalities
 Anencephaly
 Choroid plexus cysts
 Spinal anomalies
 Fetal heart
 Fetal abdomen & abdominal wall
 Omphalocele
 Hydrops fetalis
 Fetal gender identification- detection of the testes within the
scrotum in the third trimester.

18. Placenta & umblical cord
 Placenta is a echogenic discoid mass
 Placental thickness at term about 30mm- more
than 45mm at any period of gestation-
abnormal
 Placenta of multifetal pregnancy:
Dizygotic twins have always diamniotic, dichorionic
placenta(DiDi)-twin peak sign.

19. Third Trimester
 Estimated fetal weight is determined FL, AC
and BPD.
 Growth profile- IUGR- the HC is maintained but
the AC falls off around 30 weeks the HC:AC is
therefore elevated.

20. Observation Chromosomal
abnormality
Observation Chromosomal
abnormality
a)Head
•Choroid plexus cyst
•Strawberry skull
•Hydrocephalus
•Holoprosencephaly
b)Face
•Cleft lip/palate
•Low set ears
c)Nuchal translucency
•>3mm
d)Heart
•VSD, ASD
e)Renal anomalies
•Horseshoe kidney
•Bilateral dilation-renal
pelvis
•Cystic dysplasia
Trisomy 18, 13,
triploidy
Trisomy 13,18
Meckel-Gruber
syndrome
Triploidy
Trisomy 21,18 ,13,
Turner Syndrome
Trisomy 13,18, 21
Trisomy 13,18,21
Triploidy
f)Hands/feet
•Flexed overlapping fingers
•Rockerbottom/clubfoot
•Polydactyly
•Wide gap between 1st
and
2nd
toes
•Clinodactyly
•Short femur
g)G.I.System
•Omphalocele
•Duodenal atresia
h) General
•Growth restriction
•Hydrops
Trisomy 18
Trisomy 13
Trisomy 21
Trisomy 13,18
Trisomy 21
Trisomy
13,18,21
Triploidy,45,XO

21. Doppler
 Doppler velocimetry of the umbilical artery.
The umbilical artery doppler waveform is to measure
the peak systolic(s), peak diastolic(D) and mean(M)
values from these values S/D ratio and the pulsatility
index(P.I)[P.I=(S-D)/M] are calculated.
Normal pregnancy the S/D ratio and the pulsatility
index decrease as the gestational age advances
In higher values S/D and P.I mean reduced diastolic
velocities and increased placental vascular
resistance(IUGR)

22. Continued..
 Doppler velocimetry of the umbilical vein:
Normally umbilical venous flow is monophasic
Umbilical venous pulsation are often associated with raised
CVP and cardiac failure and increased perinatal mortality.
Reduced diastolic flow indicates high resistance in the
down stream vessel and low tissue perfusion. Presence of
“notch” in the early diastole waveform also indicates high
resistance to the flow.
Presence of notch in the uterine artery when confrimed
bilaterally at 24 weeks indicates the possible development
of pre-eclampsia & fetal growth restriction

23. Biochemical
 Maternal serum alpha feto protein(MSAP)
 Alfa feto protein is a oncofetal protein(Molecular Weight
70,000)
 MSAP level is elevated in a number of conditions
 1. wrong gestational age
2. Open neural tube defects
3. IUFD
4. Anterior abdominal wall defects
5. Renal anomalies

24. Triple Test
 combined MSAFP, HCG and UE3(Unconjugated
Oestriol)
It is used to detect Down’s Syndrome
ACETYL CHOLINE ESTERASE
 Amniotic fluid level is elevated in open neural tube
defects

25. Amniocentesis
 The deliberate puncture of the amniotic
fluid sac per abdomen
 Diagnostic – 14-16 weeks Genetic
disorders
 Therapeutic- Induction of Abortion by
instillation of chemicals in hypertonic
saline

26. Chorionic villus sampling
 Performed for prenatal diagnosis of
genetic disorders
 Performed 10-12 weeks of gestation
 The removal of a small tissue specimen
from the fetal portions of the placenta

27. Percutaneous umbilical Blood
sampling OR cordocentesis
 Fetal blood sampling and transfusion
 Usually done after 18 weeks gestation
 Values
 Haematological- Fetal anaemia
 Fetal Infection – Toxoplasmosis, viralinfections
 Fetal blood gas- Growth restrictions
 Fetal therapy – Blood transfusion, drug
therapy

28. Fetal pulmonary maturity
 Confirmation of lung maturation
 Assessment of severity of RH –iso
immunisation
 Bilirubin in the amniotic fluid by specto
phometric analysis