By Carissa Tomer RDMS, RVT

Have you ever wondered if you could perform Biophysical Profile (BPP) ultrasound?

The answer is yes!

To all the OBs and midwives, you already know the importance of this scan. What if you could take control and do it yourself? In certain settings where there is limited access to a sonographer or imaging department, performing a bedside BPP can make a real difference in timely decision-making for your patients. With handheld ultrasound devices more capable and accessible than ever, now is the perfect time to learn this skill.

After a short didactic training and a couple of hands-on practice sessions, you can confidently assess four of the five key parameters of the BPP, namely amniotic fluid volume, fetal breathing movements, fetal tone, and gross body movements. If you have access to a non-stress test (NST – 5th parameter), then you will have a powerful tool to monitor fetal well-being and guide delivery decisions on the spot.

Let us break down the steps so you can empower yourself with this essential skill.

Why the BPP Matters

These four ultrasound parameters are highly sensitive for detecting fetal hypoxemia, a condition in which the fetus is not receiving enough oxygen. Hypoxemia can slow or stop fetal movements, breathing, and tone. Low amniotic fluid volume can restrict fetal movements and increase umbilical cord pressure, further worsening the hypoxemia. In severe cases, untreated hypoxemia can lead to fetal death. A fetus failing all four BPP parameters is considered in distress, prompting immediate medical intervention.

How the BPP is Scored

Each of the four ultrasound parameters can receive 2 points if normal, resulting in a maximum score of 8/8. If combined with an NST, there are 2 additional points, making the maximum score 10/10. The exam is timed with a 30-minute cap, but scoring is given as soon as the parameter is observed. If all parameters are scored, you do not need to continue to monitor the fetus with ultrasound for the entire 30 minutes.

Biophysical Profile Scoring Criteria

Table 1. Biophysical Profile Scoring and Interpretation Guide with or without NST

How to perform the scan

1. Amniotic Fluid Volume

Divide the mother’s abdomen into 4 quadrants, scan each quadrant, locate the largest fluid pocket, making sure it is free of fetal parts or the umbilical cord, and measure from the anterior to the posterior wall. A normal fluid volume is at least one fluid pocket equal or greater than 2 cm. If found, give the patient 2 points for this portion of the exam.

Figure 1. Image at the top shows one fluid pocket. Image at the bottom shows how to perform the measurement of the single vertical deep pocket. Observe that the fetal part is not included in the measurement plane.

2. Fetal Breathing

Fetal breathing must consist of 30 seconds of continuous, rhythmic diaphragmatic movements to count for the 2 points. Apnea of 5 seconds or more, within 30 seconds, should not be counted as constant. Hiccups are considered a form of diaphragmatic movement; 30 uninterrupted seconds of hiccups equate to 2 points for fetal breathing. Breathing can be observed by examining diaphragmatic movements in a longitudinal view of the fetal chest and abdomen, or by visualizing color flow through the nares.

For beginners, placing the color Doppler box over the fetal nose makes it easy to visualize flow, allowing you to observe the in-and-out movement of breathing. Fetal breathing is demonstrated through the nares.

Figure 2. Image at the top shows fluid movement through the nares as red/orange (towards the transducer) and in the image at the bottom as blue (flow away from the transducer). The preferred method is to observe the diaphragm movement.

3. Fetal Tone

One episode of fetal tone is required to receive 2 points for this element. Fetal tone is defined as full extension, followed by full flexion of an arm, leg, hand, or foot. Please note that full extension and then flexion must be observed. One episode of fetal tone may count as 1 gross body movement; however, a gross body movement does not count as fetal tone.

4. Gross Body Movements

Fetal gross body movements, including rolling, shifting, stretching, or extending an extremity. A total of three gross body movements must be observed to be given the 2 points for this element.

Summary

For POCUS providers, mastering each parameter, understanding the scoring method, and recognizing the clinical significance are essential for accurate evaluation and timely intervention—ultimately safeguarding both mother and baby.

References

• https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf
• https://www.acog.org/womens-health/faqs/special-tests-for-monitoring-fetal-well-being
• https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance

Ready to learn?

Ready to learn ultrasound, expand your skills, earn CMEs, and pursue POCUS certification? We’re here to help you improve patient care with the power of POCUS.

We offer both online and in-person training. Our step-by-step, video-based online courses provide a solid foundation, while our simulated scanning platform lets you practice image acquisition and interpretation with access to thousands of real patient cases.

Let’s get you started!

Visit us at UltrasoundEnergy.com
You can also email us at: Clientservices@ultrasoundenergy.com
Or set up a consultation for in-person training here: Book a Consultation