Biophysical Profile

(BPP, Ultrasound Evaluation with a Nonstress Test)

Procedure overview

A biophysical profile is a test that’s sometimes given during your third trimester of pregnancy. It is typically done if the health of your baby is in question because of the results of another test, because of certain pregnancy symptoms, or if your pregnancy is high risk.

The biophysical profile combines two tests to fully examine the health of your unborn baby. The first is a nonstress test, which measures the baby’s heart rate and your contractions. This is accomplished with a pair of belts wrapped around the abdomen.

The second test that makes up the biophysical profile is an ultrasound evaluation. This is quite similar to the ultrasound done at other times during pregnancy. A qualified technician will use an ultrasound machine to “see” into the uterus to examine the health of your unborn baby.

Reasons for the procedure

A biophysical profile typically is not done unless there is some reason to be concerned about the health of your child. But just because your health care provider suggests a biophysical profile, it certainly doesn’t mean that there is anything wrong with your baby.

During the biophysical profile, your health care provider is looking for specific things, including movement and heart rate, that can help give him or her a sense of the overall health and well-being of your baby. The procedure can also help your health care provider determine whether your baby might need to be born early.

Risks of the procedure

The biophysical profile is a completely noninvasive procedure. The nonstress test involves having two belts wrapped around your abdomen. The ultrasound involves having ultrasound gel applied to your belly, and then an ultrasound wand moved and pressed around on your belly in order to see into your uterus.

Neither of these poses much of a risk to you or your baby. Some concern has been raised about doing ultrasounds for a lengthy period of time, but an occasional ultrasound as part of a medical procedure doesn’t seem to pose much of a risk.

There may be other risks, depending upon your specific medical condition. Be sure to discuss any concerns with your health care provider before the procedure.

Before the procedure

You don’t have to do much to prepare for a biophysical profile test. The test will be performed in your nurse midwife's, obstetrician’s, or perinatologist’s office, and no lengthy hospital stay or office visit is needed.

If needed, the test is typically performed after 32 weeks of pregnancy.

During the procedure

The biophysical profile is typically performed in a private room at your health care provider's office. You may be asked to undress and put on a medical gown to make it easier to conduct the test. The test is often done with you reclined on a doctor’s table or bed.

The tests usually start by attaching a somewhat snug belt around your abdomen. This will measure the baby’s heart rate, which will be displayed on a monitor in the procedure room.

Then a second, quite similar belt is attached right next to the first to measure your contractions. Even though labor is still a few weeks off, contractions are normal during this period of your pregnancy. This can monitor your contractions and make sure that nothing is out of the ordinary. This part of the test often lasts 20 to 30 minutes.

If the baby doesn’t move during part of the test, you shouldn’t panic. The baby might be asleep. If this happens, a nurse may try to wake the baby with a buzzer.

For the ultrasound portion of the test, an ultrasound technician will apply ultrasound gel to your bare abdomen. This part of the exam may take up to an hour.

After that, the technician will use an ultrasound camera to observe the baby within the uterus.

The ultrasound technician is observing the baby’s breathing, movement, and muscle flexing.

In some cases, the ultrasound technician can also perform a separate test to measure the uterus’ amniotic fluid and make sure there is enough present.

During the biophysical profile, the health care provider is looking at five specific things to determine the overall health and well-being of your baby:

  • At least one breathing episode within 30 minutes

  • Two or more baby movements within 30 minutes

  • One or more episodes of the baby’s moving limbs or flexing muscles, such as opening and closing a hand

  • Two or more episodes of a reactive heart rate (in which the heart rate changes in a normal way)

  • One or more adequate pockets of amniotic fluid

After the procedure

Once the biophysical profile is complete, the technician will wipe the ultrasound gel off your belly, and you can get dressed and go about your day.

Your health care provider will “score” your baby’s health based on the results of the five observations made above. If the score is lower than what your health care provider hoped to see during the biophysical profile, then he or she might suggest that you schedule your baby’s delivery earlier than expected. In these instances, the delivery would take place through induced labor or a Caesarian section.

If your baby scores in an acceptable range during your biophysical profile, your health care provider may determine that everything is OK. You can progress with your pregnancy as usual and wait for the big day to arrive on its own.