FETAL BIOPHYSICAL PROFILE - 07/09/11
Résumé |
The development of objective clinical methods for the detection of the fetus at risk for death or damage in utero did not begin in earnest until the past few decades. At its inception, objective fetal biophysical testing was limited to a single variable, the fetal heart rate, and antepartum testing methods, including the oxytocin challenge test and its variants such as the spontaneous contraction stress test (CST), were extrapolated from intrapartum observation.30, 34 Almost from the outset of antepartum fetal heart rate monitoring, it was recognized that the record contained important information even in the absence of uterine contraction responses. Specifically, the association of fetal movement at heart rate acceleration, the basis of the nonstress test (NST), was recognized to be of prognostic value.9
At around the same time, Dawes and colleagues6 were able to demonstrate an exquisite sensitivity of the fetal respiratory center to experimental hypoxemia in a series of elegant experiments in the chronic fetal lamb preparation, raising interest in the potential of this measurement in predicting human fetal compromise. By the mid 1990s, the revolutionary clinical tool of dynamic real-time B-mode ultrasound became available, and, through this method, observation of a broad range of dynamic fetal biophysical activities became a clinical reality. From the nascence of this new clinical testing modality, it was evident that observation of the presence or absence of breathing movements in the human fetus was as predictive as the NST,12 was useful in the differentiation of true-positive and false-positive CST results,13 and, when combined with the heart rate test, yielded a better prediction of the risk of fetal death or compromise than any single test.14 Furthermore, it became evident that objective recording of gross body movements was predictive of fetal health and disease,15 and that when this information was combined with other biophysical variables, predicative accuracy was improved. The preliminary observations provided a first insight into a fundamental tenet of antepartum risk assessment, that is, the predictive accuracy of fetal testing methods improves as more fetal variables are considered. From these observations, the new concept of composite fetal assessment arose. The fetal biophysical profile scoring (BPS) method emerged from this rich clinical milieu as a means of integration of dynamic biophysical activities into a workable clinical format.16
This article reviews the clinical role of the fetal BPS in the prediction and prevention of perinatal mortality and perinatal morbidity as reflected by antenatal acidosis, immediate neonatal compromise, and long-term sequelae. Application of the testing method to discrete at-risk pregnancy categories is described.
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| Address reprint requests to Frank A. Manning, MD, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Room 512, Bronx, NY 10461 |
Vol 26 - N° 4
P. 557-577 - décembre 1999 Retour au numéro
Article précédent
- NONSTRESS TESTING AND CONTRACTION STRESS TESTING
- Lawrence D. Devoe
- AMNIOTIC FLUID VOLUME ASSESSMENT IN SINGLETON AND TWIN PREGNANCIES
- Everett F. Magann, James N. Martin
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