Resources for interpreting biophysical profile

[AutumnAir]

Hi - well I'm 42+1 weeks today (though my care providers believe me to be 41+1, since I had DD at 43+1 weeks last time and encountered a huge amount of pressure I thought it would be a good idea to buy myself a bit of extra time).

On Monday I need to go into the hospital for a NST and a scan, to check amniotic fluid levels - I'm assuming it's some kind of BPP. Since I have previously encountered *many* doctors who assume that you're too stupid to understand anything, and who are prepared to actively lie to you in order to coerce you into doing what they want you to do, I would like to be armed with as much knowledge as possible going into this.

For example, exactly what constitutes oligohydramniosis? What kind of measurements? Is there any possibility that those measurements could be 'off'? And is oligohydramniosis on its own (i.e. everything else looks fine) a good enough reason to induce?

What else are they looking for? What are the normal/acceptable ranges for those? What are the margins of error? (E.g. I already know that ultrasounds can be off by a few pounds when it comes to estimating baby's size, so I certainly won't let myself be bullied by 'huge baby' predictions.)

I'd like to be able to assume that they will do their best to make a fair assessment, and then give me all the information objectively - but my previous experience has told me that that's unlikely at best. So, for my own peace of mind, I'd really like to have as much information at my fingertips as possible, so that I can make a properly informed decision.

Anybody have any info and links to studies/research/charts etc? TIA

[JBaxter]

Its been a while ( Jack is almost 2) but I had biophysical profiles every week after 34 weeks because I was over 40 ( yeah I know but it kept everyone off my back)

I think the level should be 5 or over but less than 20? We tracked Jack because of his size and my u/s tech who did all my u/s had him dead on in size weight and head. She was good.

It is possible for the baby to hide a fluid pocket. "ME" I wouldnt worry if it was close to 5 I was always like 10-15 it did vary alot
They measured his size, movement head & chest circum., practice breathing times, and fluid levels.

I usually ate something with a bit of sugar before going in just so he moved a bit for her. Jack didnt move much at the end He was out of room. ( almost 23in 10lb1oz and 15 1/2 in head)

[womenswisdom]

Here is a breakdown of the parameters they look for in a BPP: http://emedicine.medscape.com/article/405454-overview

This article addresses oligohydramnios, but it's an article about that finding at terms, and you are now post-term, so the same information may not apply: http://www.jfponline.com/pages.asp?aid=1847&UID=

[Jenne]

Having witnessed a a BPP where the ultrasound tech was "in training" and being guided by someone with more experience I believe with 100% of my being that the results can be effected the tech.

I would suggest that if the first BPP reveals a problem your first course of action is to request another BPP with a different tech.

The measurements, even catching the baby breathing, take such skill but also finesse that I'd want to make sure I had 2 BPP with issues before I did further testing.

Best of luck! I hope everything goes splendidly!

Jenne

[MsBlack]

You have gotten some good info and advice...just want to say that for me, if 2 techs both found 'almost no amniotic fluid', then I would want baby out in another day or 2 at most.

I've not seen much of this--but the couple times I have, extremely low af is observable on palpation. Baby has a 'shrink-wrapped' feeling, unless you're pretty fluffy it becomes easy to see contours and parts through the belly in a sharper more distinct way than before. Even for the fairly fluffy or moreso, it can still be felt with hands, especially if someone has been palpating all along to be able to detect the difference in feeling now (if that makes sense).

The risk of cord compression/accident rises when afi is extremely low. But I do mean extremely low--not just lower, which is pretty normal for late gestation weeks anyway. And I have seen/felt that shrink-wrapped thing that helps me tally my own perceptions with u/s results.

[lis0928]

This is a link to an amniotic fluid index chart. It goes up to 42 weeks. http://www.fetalanomalies.org/Fluid.html

In my experience, the measurements for amniotic fluid vary A LOT depending on who is doing the measuring. Some people find the obvious pockets and leave it at that, others spend more time looking around for slivers of fluid, which can really add up.

On activity level, some will bounce the probe on your belly or want to "buzz"
the baby. Others will say "oh, baby's sleeping." I have found drinking some orange juice right before the BPP tends to result in a more active baby.

I would also push water before the BPP. And, if they tell you something is "borderline" problemmatic, I'd ask for a second BPP the next day.

I hope all goes well!

[AutumnAir]

Thanks everyone - this is exactly the sort of info I'm looking for. I had wondered about eating/drinking something sugary to wake baby up, especially since the BPP is in the morning which is baby's normal 'quiet time'. I do think my fluid levels have gone down a bit, though not to the 'shrink-wrapped extent. And lower fluid levels are pretty normal in late pregnancies, from what I understand. I'm making sure to drink at least 3 litres of water a day to make sure we both stay hydrated.

It's a good idea to ask for a second opinion - I think I'd read before that the skill of the U/S tech made quite a difference to the results, so it's good to have that confirmed. And if baby's sleeping I'll definitely ask if they can try to wake it up.

Thanks everyone!

Oh, and one more question - how long does the BPP take? From what I've read it says up to 30 minutes, which seems like a really long time for the baby to be exposed to ultrasound. I'm okay with a small amount of exposure where I feel the benefits outweigh the risks - e.g. we had a quick scan at 20 weeks - but I'm a bit concerned about exposing baby to 30 minutes of ultrasound every few days from now on, YK?

[lis0928]

Originally Posted by AutumnAir

Oh, and one more question - how long does the BPP take? From what I've read it says up to 30 minutes, which seems like a really long time for the baby to be exposed to ultrasound. I'm okay with a small amount of exposure where I feel the benefits outweigh the risks - e.g. we had a quick scan at 20 weeks - but I'm a bit concerned about exposing baby to 30 minutes of ultrasound every few days from now on, YK?

I am not sure about a BPP done "post-date" but I have had several during this pregnancy because my water broke at about 29 weeks, and some of them have been really quick. Maybe 10 minutes, often shorter.

[SubliminalDarkness]

Originally Posted by AutumnAir

Oh, and one more question - how long does the BPP take? From what I've read it says up to 30 minutes, which seems like a really long time for the baby to be exposed to ultrasound. I'm okay with a small amount of exposure where I feel the benefits outweigh the risks - e.g. we had a quick scan at 20 weeks - but I'm a bit concerned about exposing baby to 30 minutes of ultrasound every few days from now on, YK?

It should only be about 10-15 minutes. With DS2, I ended up having one take over an hour. My OB was amazing and he was trying to help me buy time to go into labor on my own. But in that over an hour period, DS2 didn't make any significant movements. He had me drink a 7UP, we shined light at him, we used the buzzer, he had me walk around, go to the bathroom, various things..... nada. So we induced that evening. For the record, I am completely ok with this and felt(and still feel) it was the right decision.

But anyway. The point being, the BPP shouldn't take very long at all.

[Baby~Braatens~Mama]

We just had a BPP on Thursday and it took about a half an hour... not the measuring itself, but after the "business" of it the tec seemed quite taken with my little man and pulled out the 3D wand. She spent half of our time in the room trying to get a good profile pic for us but he was so very busy, even though he was sleeping (licking his lips, breathing, cuddling his face with his hand) that it was hard to get a good image.

I hope that all goes well for you and your LO. I look forward to your udate!

[Jenne]

From the BPP I observed, we were told that they have 30 minutes to see all of the things on the checklist- practice breathing, movement, take af measurements, see the heartbeat. In our case, baby was sleeping (it was her normal "bedtime" and she just refused to be awoken. At minute *29* she finally breathed. We had been waiting for that breath from about minute 8 on. So, it could take much less time if baby is awake and active. Since you commented that you are scheduled for a time when your babe is normally less active you might try to reschedule for a time that is more naturally his active time...just a thought if you are concerned about the ultrasound waves.

Good luck and take care!
Jenne

[Megan73]

Two things,
The book "Management of high-risk pregnancy: an evidence-based approach" (it's full text on Google books) has a good explanation fetal monitoring and how BPPs are scored.
Also, the WHO recently did a research review that found obstetrical ultrasound is safe. Someone posted it recently.