Is the intrapartum biophysical profile useful?
OBJECTIVE
To assess the role of biophysical profile (BPP) during normal labor. The secondary goal was to assess the effect of oxytocics, regional anesthesia, and ruptured membranes on fetal behavior during labor.


METHODS
The BPP (according to the Manning criteria) was performed prospectively in 100 normal, singleton pregnancies in active labor. To evaluate its role in the prediction of cesarean delivery and admission to the neonatal intensive care unit (NICU), statistical analysis included chi2 and Fisher exact tests for frequency analyses and t tests for comparisons of continuous data.


RESULTS
At the mean cervical dilatation of 5.2+/-1.4 cm, 73 women had a BPP score of at least 8/10, 16 had 6/10, six had 4/10, and five had 2/10. The BPP was not influenced by use of oxytocics, prostaglandins, or epidural anesthesia. Fetal breathing (95% versus 71%; P=.002) and gross fetal movements (98% versus 84%; P=.04) decreased with rupture of amniotic membranes. A BPP score of 6/10 or less in labor was associated with a relative risk (RR) for cesarean delivery of 8.00 (95% confidence interval [CI] 2.4, 26.5). Cessation of any ultrasound component of BPP significantly increased the risk of cesarean delivery and admission to the (NICU) (RR=29; 95% CI 2.73, 308.66). In the multivariable analysis, however, fetal movements and amniotic fluid volume were most important in predicting the need for cesarean delivery.


CONCLUSIONS
Fetal heart rate monitoring alone did not predict the need for cesarean delivery or neonatal outcome, whereas the BPP did. Biophysical profile could prove to be a clinically useful adjunctive tool in the assessment of fetal well-being in labor.
Kim
So Young
SY
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Khandelwal
Meena
M
Gaughan
John P
JP
Agar
Mehmet H
MH
Reece
E Albert
EA
D000328:Adult; D002585:Cesarean Section; D016001:Confidence Intervals; D005314:Embryonic and Fetal Development / Q000502:physiology*; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D005323:Fetal Monitoring / Q000379:methods*; D005324:Fetal Movement / Q000502:physiology; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007745:Labor Onset; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016017:Odds Ratio; D010298:Parity; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal