Similar studies have substantiated these findings. Salvesen and associates (1993) concluded that the biophysical proile was of limited value in the prediction of fetal pH. Weiner and coworkers (1996) assessed 135 overtly growth-restricted fetuses and came to a similar conclusion. Kaur and colleagues (2008) performed daily biophysical proiles to ascertain the optimal delivery time in 48 growth-restricted preterm fetuses that weighed less than 1000 g. Despite scores of 8 in 27 fetuses and 6 in 13, there were six deaths and 21 acidemic fetuses. Lalor and associates (2008) performed a Cochrane review and concluded that there is insuicient evidence to support the use of the biophysical proile as a fetal well-being test in high-risk pregnancies.
Because the biophysical proile is labor intensive and requires a person trained in sonography, Clark and coworkers (1989) used an abbreviated biophysical proile as a irst-line screening test in 2628 singleton pregnancies. Speciically, a vibroacoustic nons tress test was performed twice weekly and combined with
TABLE 17-3. Interpretation of Biophysical Profile Score 10 Normal, nonasphyxiated fetus 8/10 (Normal AFV) Normal, nonasphyxiated fetus 8/8 (NST not done) 8/10 (Decreased AFV) Chronic fetal asphyxia suspected 6 Possible fetal asphyxia o to 2 Almost certain fetal asphyxia
If amnionic fluid volume abnormal, deliver
If normal fluid at >36 weeks with favorable cervix, deliver If repeat test :;6, deliver
If repeat test >6, observe and repeat per protocol
Repeat testing same day; if biophysical profile score :;6, deliver Deliver
AFV = amnionic fluid volume; NST = nonstress test.
Reproduced with permission from Manning FA, Morrison I, Harman CR, et al: Fetal assessment based on fetal biophysical profile scoring: experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths, Am J Obstet Gynecol. 1987 Oct;157(4 Pt 1 ):880-884.
I.
):J0 downstream impedance (Chap. 10, p. 213). For growth 7.30 7.25 0E:J
E:J= 7.20 7.10 7.05
FIGURE 17-9 Mean umbilical vein pH (±2 SD) obtained by cordocentesis in relation to fetal biophysical profile score category. (Data from Manning, 1993.)
API determination for which �5 cm was considered abnormal (Chap. 11, p. 230). his abbreviated biophysical proile required approximately 10 minutes to perform, and they concluded that it was a superb antepartum surveillance method because there were no unexpected fetal deaths.
Nageotte and colleagues (1994) also combined biweely nons tress tests with the AFI and considered measures �5 cm to be abnormal. They performed 17,429 modiied biophysical proiles in 2774 women and concluded that such testing was an excellent fetal surveillance tool. Miller and associates (1996a) reported results with more than 54,000 modiied biophysical profiles performed in 15,400 high-risk pregnancies. They described a false-negative rate of 0.8 per 1000 and a falsepositive rate of 1.5 percent.
The American College of Obstetricians and Gynecologists (2016) has concluded that the modiied biophysical proile test is as predictive of fetal well-being as other approaches to biophysical fetal surveillance.