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.

Conclusion: 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.