A modified scheme for biophysical profile scoring

Doppler and B-mode ultrasonography in biophysical profile scoring

OBJECTIVE

Biophysical profile scoring (BPS) is a valuable antepartum test for establishing fetal well-being, although the time constraint in some clinics limits its extensive use. In this study we attempted to shorten the total test time without excluding any of the test components.

METHOD

The non-stress test (NST) part of the BPS was performed using simultaneous pulsed wave Doppler and B-mode ultrasonography (duplex NST). It was possible to observe all the components of the BPS during the same period (duplex BPS).

RESULTS

Fifty-four tests were performed on 40 pregnant patients. The mean test time was 14.3 min. A discrepancy was shown between the ultrasonographic observation and the women's perception of the fetal movements in 46% of the tests.

CONCLUSION

Duplex NST is considered a more reliable test than the classical cardiotocographic NST. Duplex BPS is proposed as an easy-to-perform, compact and time-saving modification to the classical BPS.

Preterm premature rupture of membranes: detection of infection

This prospective study was designed to determine the value of a daily modified biophysical profile in detecting infection in patients with preterm premature rupture of the membranes who were managed expectantly. Ninety-nine patients received daily nonstress tests and biophysical profile scores. Results of the last predelivery study were related to subsequent development of amnionitis or fetal sepsis. Infection was present in 16 patients. When the biophysical profile score was 0/8, infection was uniformly present. When fetal breathing was absent (biophysical profile score, less than or equal to 4/8) and nonstress test was nonreactive, infection was present in 75% of cases (sensitivity, 75%; specificity, 95%). Because a nonreactive nonstress test could be secondary to prematurity instead of infection, these results were analyzed over time. Those who initially had a reactive nonstress test that subsequently became nonreactive were more likely to be infected. We conclude that a daily biophysical profile score and nonstress test can detect infection and propose delivery of patients with a biophysical profile score of 0/8 and nonreactive nonstress test. Patients with absent fetal breathing and a nonstress test that changes from reactive to nonreactive also should be considered for delivery. Absent fetal breathing with a reactive nonstress test or a consistently nonreactive nonstress test should have further testing to rule out infection.