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Old 03-30-2011
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ObGyn What constitutes an equivocal biophysical profile (BPP)?

What constitutes an equivocal biophysical profile (BPP) where we should proceed to contraction stress testing (CST)?
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Old 03-31-2011
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Haisook, here is what I found for equivocal BPPs:

6 or 8/10 (0 points for amniotic fluid): when amniotic fluid volume is decreased, the risk of developing fetal asphyxia within one week if no intervention is increased at 89/1000.

6/10 (includes 2 points for amniotic fluid): equivocal test, significant possibility of developing fetal asphyxia cannot be excluded. Repeat test within 24 hours to see if one of the absent acute variables returns to normal or deliver if at or near term.

I don't see (in the literature) any direct steps between BPP and CST. I suspect one reason you are finding yourself confused is that there is very little evidence (if any) for these expensive, invasive, and time-consuming tests. (Please excuse my bias against US OB practices.) In terms of when to do CST, here is what I found in UTD:

There is no evidence from randomized trials that proves antepartum FHR monitoring results in a decreased risk of fetal death. Nevertheless, antepartum fetal monitoring of pregnancies deemed to be at high risk of adverse fetal outcome is a routine obstetric practice in the United States, and elsewhere, based upon circumstantial evidence. For liability exposure reasons, it is impossible to abandon use of these tests in the United States while awaiting data from well-designed randomized trials, which may never be performed.

My interpretation then is that you may want to just do these tests on every patient, since you will rest easier knowing you will never be sued for not doing it. (Please excuse my frustration with medical practices being guided by legitimate fears of litigation.)
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Old 04-01-2011
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Default BPP

BPP previously consisted of 5 parameters, that was the classical one

But the modified one consists of only NST and amniotic fluid volume
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Old 04-01-2011
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"The modified biophysical profile was developed to simplify the examination and reduce the time necessary to complete testing by focusing on those components of the profile that are most predictive of outcome. Assessment of amniotic fluid volume and nonstress testing appears to be as reliable a predictor of long-term fetal well-being as the full BPS. A normal modified biophysical profile will occur in 90 percent of pregnancies tested, thus it is necessary to proceed with a full biophysical evaluation in only a minority of patients. The rate of stillbirth within one week of a normal test is the same as with the full BPS, 0.8 per 1000 women tested." UTD

If either the NST or the AFI is abnormal, a complete BPP or a contraction stress test (CST) is performed, so those values still stand as the equivocal results of the BPP.
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From what I've gathered, and in general, a BPP score of less than 4 indicates delivery, while a score of 4-6 is considered equivocal.

I think we should repeat the BPP (or do CST) in 24 hours in case of an equivocal score.

There are other criteria that play a role like the gestational age and the AFI, but it gets so complicated.
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Old 04-01-2011
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Yes I agree with yoru last paragraph. That's true.

Quote:
Originally Posted by healer2b View Post
Haisook, here is what I found for equivocal BPPs:

6 or 8/10 (0 points for amniotic fluid): when amniotic fluid volume is decreased, the risk of developing fetal asphyxia within one week if no intervention is increased at 89/1000.

6/10 (includes 2 points for amniotic fluid): equivocal test, significant possibility of developing fetal asphyxia cannot be excluded. Repeat test within 24 hours to see if one of the absent acute variables returns to normal or deliver if at or near term.

I don't see (in the literature) any direct steps between BPP and CST. I suspect one reason you are finding yourself confused is that there is very little evidence (if any) for these expensive, invasive, and time-consuming tests. (Please excuse my bias against US OB practices.) In terms of when to do CST, here is what I found in UTD:

There is no evidence from randomized trials that proves antepartum FHR monitoring results in a decreased risk of fetal death. Nevertheless, antepartum fetal monitoring of pregnancies deemed to be at high risk of adverse fetal outcome is a routine obstetric practice in the United States, and elsewhere, based upon circumstantial evidence. For liability exposure reasons, it is impossible to abandon use of these tests in the United States while awaiting data from well-designed randomized trials, which may never be performed.

My interpretation then is that you may want to just do these tests on every patient, since you will rest easier knowing you will never be sued for not doing it. (Please excuse my frustration with medical practices being guided by legitimate fears of litigation.)
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Old 04-01-2011
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useful learing points.

thanks

Quote:
Originally Posted by Haisook View Post
From what I've gathered, and in general, a BPP score of less than 4 indicates delivery, while a score of 4-6 is considered equivocal.

I think we should repeat the BPP (or do CST) in 24 hours in case of an equivocal score.

There are other criteria that play a role like the gestational age and the AFI, but it gets so complicated.
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Old 04-03-2011
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I was just looking a little closer at the scoring, and I noticed that all the findings are assigned 2 points (I have no idea why they didn't just make it 1).

Given that the scoring only produces even numbers, 6 is really the only "equivocal" score. The following is the simplified score interpretation:

8 or 10: reassuring
6: equivocal (term pregs are usually delivered)
0, 2, or 4: extremely worrisome for fetal asphyxia (immediate delivery if no good explanation found)
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Old 04-04-2011
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Default Haisook, you are making me think today...hehe

ok, I had to go look at my protocol again, it is 4 months since I did my Ob rotation:
I would write the whole thing from decrease fetal movement...lol... but can't make algorithm with arrows so might get confusing:
but here is what to do when you get to BPP

BPP 8-10---> reassuring--> repeat Q week or PRN
BPP 0-2---> fetal hypoxia---> Deliver
Bpp 4-6---> Worrisome--> Management is 2 ways, I am sure both paths will not be in one question but just know in case one or other appears as answer.
1.Do Contraction stress test (CST) if
Positive CST--> Deliver
Negative CST-->Good, repeat BPP PRN
Alternatively
2. if >36 weeks --> deliver & if <36 weeks repeat BPP in 12-24hrs

Hope it helps,

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