A Biophysical Profile (BPP) is a safe, non-invasive, and highly reliable prenatal test used to assess a baby's overall health and well-being in the womb. It is essentially a fetal physical examination that combines a detailed ultrasound assessment with a non-stress test (NST) to evaluate key markers of fetal health. The BPP is typically performed in the third trimester of pregnancy and is recommended for pregnancies that are considered high-risk or when there is a concern about the baby's condition.

The test checks five specific variables: your baby's breathing movements, body movements, muscle tone, the amount of amniotic fluid, and the heart rate pattern.

Each of these components acts as an indirect indicator of the health of the baby's central nervous system and their ability to thrive in the uterine environment. The results are given as a simple score, providing your doctor with a clear and immediate picture of your baby’s current state, helping to guide decisions about the management of your pregnancy and the timing of delivery.

What is a Biophysical Profile (BPP)?

A biophysical profile is a composite test that integrates five separate assessments of fetal well-being into a single, easy-to-interpret score. It is based on the principle that a healthy, well-oxygenated fetus will exhibit specific, observable behaviors. A reduction in these activities can be an early sign of fetal compromise. The five components of a full BPP are:

1. Non-Stress Test (NST):

This part of the test evaluates the baby's heart rate and its response to movement. A healthy baby's heart rate will temporarily accelerate when they move.

• How it's done: Two elastic belts with sensors are placed around your abdomen. One sensor tracks your baby's heartbeat, and the other detects uterine contractions. You may be given a button to press each time you feel your baby move.
• What it means: A reactive NST (the normal, reassuring result) shows the baby's heart rate accelerating by a certain amount for a certain duration after they move. This indicates a well-functioning and well-oxygenated nervous system.

2. Fetal Breathing Movements (Ultrasound Component):

Although the baby is not breathing air, they make continuous, rhythmic, practice-breathing movements with their chest and diaphragm.

• How it's observed: The fetal medicine specialist uses the ultrasound to watch the baby's chest wall for at least one episode of sustained rhythmic breathing movements lasting for 30 seconds within a 30-minute window.
• What it means: The control center for breathing is in the brainstem. The presence of these movements is a strong indicator of a healthy, non-acidotic central nervous system.

3. Gross Fetal Body Movements (Ultrasound Component):

This component assesses the baby's general activity level.

• How it's observed: The specialist watches for at least three distinct movements of the baby's body or limbs (such as kicking, rolling, or large trunk movements) within a 30-minute period.
• What it means: Active movement is a clear sign that the baby is healthy and receiving adequate oxygen.

4. Fetal Muscle Tone (Ultrasound Component):

This looks for evidence of a healthy, responsive nervous system through fine motor movements.

• How it's observed: The specialist looks for at least one episode of the baby extending a limb and then quickly returning it to a flexed position, or opening and closing a hand.
• What it means: Good fetal tone indicates that the baby's central nervous system is mature and not compromised by low oxygen levels.

5. Amniotic Fluid Volume (AFV) (Ultrasound Component):

The amount of amniotic fluid surrounding the baby is a crucial marker of both placental function and fetal well-being.

• How it's measured: The sonographer measures the amount of fluid, usually by identifying the single deepest vertical pocket of fluid or by calculating the Amniotic Fluid Index (AFI), which involves measuring the deepest pocket in all four quadrants of the uterus.
• What it means: Most of the amniotic fluid in the second half of pregnancy is composed of fetal urine. Adequate fluid volume indicates that the baby is receiving enough blood and nutrients from the placenta to produce a good amount of urine, which reflects healthy kidney function and good blood flow. Low fluid (oligohydramnios) can be a sign of placental insufficiency.

The Biophysical Profile Scoring System

The BPP is straightforward to interpret. Each of the five components is given a score of either 2 (if normal) or 0 (if abnormal). There are no partial scores. These scores are then added up for a total score out of 10.

• Score of 10 out of 10: This is a perfect score and is highly reassuring. It indicates that the baby is healthy and the risk of fetal compromise in the next week is extremely low.
• Score of 8 out of 10: This is also considered a normal and reassuring result, especially if the amniotic fluid volume component received a score of 2.
• Score of 6 out of 10: This is considered an equivocal or ambiguous result. It does not necessarily mean the baby is in distress, as they may simply be in a sleep cycle. The typical recommendation is to repeat the test within 12 to 24 hours or proceed with further evaluation.
• Score of 4 out of 10: This is an abnormal result and is concerning. It suggests a higher probability of fetal compromise. Your doctor will likely recommend further action, which may include closer monitoring or delivery.
• Score of 2 or 0 out of 10: This is a critically abnormal result indicating a high likelihood of significant fetal compromise. Immediate intervention, usually delivery, is almost always recommended.

A Modified Biophysical Profile (mBPP) is also commonly used. This is a shorter screening test that combines just the Non-Stress Test (NST) with the Amniotic Fluid Volume assessment. If both of these are normal, it is highly reassuring. If either is abnormal, a full BPP is then performed.

When is a Biophysical Profile Recommended?

The BPP is not a routine test for all pregnancies. It is a specialized surveillance tool for pregnancies where there is an increased risk of complications or concerns about the baby's health. Common indications include:

Post-Term Pregnancy: If your pregnancy extends beyond 41 weeks, regular BPPs are used to monitor the baby and the health of the aging placenta.

Decreased Fetal Movement: If you report a noticeable decrease in your baby's movements, a BPP is one of the first tests performed to check on their well-being.

Maternal Health Conditions: For mothers with pre-existing or pregnancy-related conditions that can affect placental function and fetal oxygenation, such as:

• Gestational Diabetes or Pre-existing Diabetes.
• Preeclampsia or Chronic High Blood Pressure.
• Chronic Kidney Disease.
• Autoimmune disorders like Lupus.

Fetal Growth Restriction (IUGR): If an ultrasound indicates that the baby is not growing at a normal rate.

Multiple Gestation: Pregnancies with twins, triplets, or more are at higher risk for complications, and BPPs are often used for surveillance.

Abnormal Amniotic Fluid Levels: If a routine ultrasound shows too little fluid (oligohydramnios) or too much fluid (polyhydramnios).

• Previous Pregnancy Complications: A history of a previous stillbirth or other adverse outcome.

Our Specialists

The performance and interpretation of a biophysical profile require a high level of expertise in fetal ultrasound and high-risk obstetrics. Our Fetal Medicine units are led by specialists dedicated to providing the highest standard of care.

Dr. SEEMA THAKUR

SENIOR CONSULTANT FETAL MEDICINE | Fortis Shalimar Bagh

Dr. Jayati Dureja

CONSULTANT FETAL MEDICINE | Fortis La Femme GK

Dr. Joyce Jayasheelan

CONSULTANT OBSTETRICS & GYNAECOLOGY | Fortis BG Road

Patient Stories

“Because I developed gestational diabetes, my doctor recommended weekly biophysical profiles starting at 32 weeks. At first, I was anxious about so much testing, but it quickly became the most reassuring part of my week. Lying there, watching my baby practice breathing and kicking on the screen, and seeing that perfect 10/10 score every time gave me such peace of mind. It felt like a weekly wellness check-in that confirmed my baby was thriving despite my high-risk condition”.  — N. Sharma, 34, Gurugram

“Around 38 weeks, I noticed my baby wasn't moving as much as usual. I called my doctor, and they had me come in for a BPP immediately. The test was so thorough. The team was calm and explained everything they were looking at. The score was good, and the test showed he was likely in a prolonged sleep cycle. It was an incredible relief. The BPP provided a clear, objective answer when I was full of worry and helped us make an informed decision to continue the pregnancy safely”.  — A. Patel, 29, Delhi

The Biophysical Profile Procedure: A Detailed Walkthrough

Preparation for the Procedure:

There is very little special preparation needed for a BPP.

• You may be advised to eat a meal or drink something sweet just before the test to help encourage the baby to be more active.
• You may be asked to have a partially full bladder, especially if you are in the earlier stages of the third trimester, as it can help to get a clearer ultrasound image.

What Happens During the Test (Typically takes 30 to 60 minutes):

The test is conducted in two parts, often in the same room.

Part 1: The Non-Stress Test (NST)

• You will lie comfortably in a reclining chair or on an examination bed.
• Two belts with electronic sensors will be placed around your abdomen. One monitors the baby's heart rate, and the other detects any contractions.
• This part of the test usually lasts for 20 to 30 minutes. You will listen to the sound of your baby's heartbeat.

Part 2: The Ultrasound Assessment

• After the NST, an ultrasound technician or fetal medicine specialist will perform the ultrasound.
• You will lie on your back, and a clear, water-based gel will be applied to your abdomen.
• The specialist will move a transducer over your abdomen to get images of the baby. They will then systematically observe and score the four ultrasound components: the baby's breathing movements, gross body movements, fetal tone, and the amniotic fluid volume. This process can take up to 30 minutes.

The entire procedure is painless and non-invasive.

After the Test: Interpreting Your Results and Next Steps

The results of the BPP are available immediately at the end of the test. Your doctor will discuss the final score with you and what it means for the management of your pregnancy.

• A Normal Score (8 or 10): This is highly reassuring. No immediate intervention is needed, and the test will be repeated as scheduled (e.g., weekly or bi-weekly).
   
• An Equivocal Score (6): Your doctor will evaluate the entire clinical picture. This may involve repeating the test in 12-24 hours. If the low score is due to low amniotic fluid, your doctor might recommend further evaluation or delivery.
   
• An Abnormal Score (4 or less): This suggests the baby may be experiencing a lack of oxygen. Your doctor will likely recommend immediate action. Depending on your gestational age and the overall situation, this could mean admitting you to the hospital for continuous monitoring or proceeding with delivery of the baby.

Myths vs Facts

Take the Next Step

Navigating a high-risk pregnancy can be a time of heightened anxiety and uncertainty. The biophysical profile is a powerful and reassuring tool that provides a window into your baby's world, offering a clear and objective assessment of their health. It allows your medical team to make proactive, evidence-based decisions to ensure the safest possible outcome for you and your child.

If your doctor has recommended a BPP, our team of fetal medicine experts is here to provide you with the highest level of care, using state-of-the-art technology and a compassionate, patient-centered approach.

CTA: Book a Fetal Medicine Consultation | Get a Second Opinion

Frequently Asked Questions

1. Is a biophysical profile painful?

Ans. No, the procedure is completely painless and non-invasive. The NST involves comfortable belts placed on your abdomen, and the ultrasound is a standard procedure involving gel and a transducer on your skin.

2. How long does a BPP take to complete?

Ans. You should plan for the appointment to last about an hour. The NST portion typically takes 20-30 minutes, and the ultrasound portion can take up to 30 minutes, especially if the baby is in a sleep cycle and not very active.

3. What happens if my baby is asleep during the test?

Ans. It is very common for babies to have quiet sleep cycles. If your baby is not moving enough for the NST or the ultrasound portion, the technician may try to wake them up by using a small acoustic stimulator (a device that makes a gentle buzzing sound) on your abdomen or by having you drink something cold and sugary.

4. What is the difference between a BPP and a kick count?

Ans. A kick count is an informal method where you track your baby's movements at home. A BPP is a formal, comprehensive medical test that evaluates multiple specific parameters in a clinical setting. While kick counts are important for daily monitoring, a BPP provides a much more detailed and objective assessment.

5. Do I need to have a full bladder for the BPP?

Ans. In the third trimester, a full bladder is usually not necessary for a BPP, as the baby is large enough to be seen clearly. However, you should follow the specific instructions given to you by the clinic when you schedule your appointment.

6. Is there a risk to the baby from the procedure?

Ans. No, there are no known physical risks or side effects to either the mother or the baby from a biophysical profile. It uses only safe ultrasound waves and external monitors.

7. Can a BPP tell me the sex of my baby?

Ans. While the baby's gender may be visible on the ultrasound, the purpose of a BPP is to assess fetal well-being. In India, under the PC-PNDT Act, the disclosure of the sex of the fetus is illegal and will not be done.

8. How often will I need to have a BPP?

Ans. The frequency depends on your specific medical condition. For most high-risk pregnancies, a BPP is performed once or twice a week until delivery.