Biophysical Profile (BPP)
A biophysical profile (BPP) test measures the health of your baby
(fetus) during pregnancy. A BPP test may include a
nonstress test with
electronic fetal heart monitoring and a
fetal ultrasound. The BPP measures your baby’s heart
rate, muscle tone, movement, breathing, and the amount of
amniotic fluid around your baby.
A BPP is
commonly done in the last
trimester of pregnancy. If there is a chance that your
baby may have problems during your pregnancy (high-risk pregnancy), a BPP may be done by 32 to 34 weeks or earlier. Some women
with high-risk pregnancies may have a BPP test every week or twice a week in
the third trimester.
Why It Is Done
A biophysical profile (BPP) test is done
- Learn about and keep track of your baby’s
health. Special ultrasound methods are used to keep track of movement,
increases in heart rate with movement (nonstress test), muscle tone, breathing
rate, and the amount of amniotic fluid (amniotic fluid index) surrounding your baby. If these five areas are within a normal
range, your baby is considered to be in good health.
- Check on your
baby’s health if you have:
- Chronic kidney
- Type 1 diabetes or
- High blood pressure (hypertension).
- A small amount of amniotic
fluid (oligohydramnios) or too much amniotic fluid
- A multiple pregnancy (such as twins or
- A pregnancy that has gone past your due date, between 40 and
How To Prepare
You may need a full
bladder for the test. If so, you will be
asked to drink water or other liquids just before the test and to avoid
urinating before or during the test. Usually women in the third trimester do not need to have a full bladder.
If you smoke, you will be
asked to stop smoking for 2 hours before the external monitoring test because
smoking decreases your baby’s activity.
Talk to your doctor about any concerns you have regarding the need for the test, its
risks, how it will be done, or what the results may mean. To help you
understand the importance of this test, fill out the
medical test information form (What is a PDF document?).
How It Is Done
Most often, a biophysical profile (BPP)
is performed by your
obstetrician. But it may be done by an ultrasound
radiologist. A BPP can be done in your doctor’s
office, hospital, or clinic.
nonstress test with electronic fetal heart monitoring
and a fetal ultrasound are done as part of a biophysical profile. A nonstress test helps check the baby’s health by looking at the baby’s heart rate with movement.
Some doctors may use a modified biophysical
profile, which combines a nonstress test and measurements of the amniotic fluid
(amniotic fluid index).
External fetal heart monitoring
records your baby’s heart rate while your baby is moving and not moving. It is
usually done just before a fetal ultrasound.
is done using two flat devices (sensors) held in place with elastic belts on
your belly. One sensor uses reflected sound waves (ultrasound) to keep track
of your baby’s heart rate. The other sensor measures the duration of your
contractions. The sensors are connected to a machine that records the
information. Your baby’s heartbeat may be heard as a beeping sound or printed
out on a chart.
If your baby moves or you have a contraction, you
may be asked to push a button on the machine. Your baby’s heart rate is
recorded and compared to the record of movement or your contractions. This test
usually lasts about 30 minutes.
Often you do not need to remove
your clothes for the ultrasound test; you can lift your shirt and push down the
waistband of your skirt or pants. If you are wearing a dress, you will be given
a cloth or paper covering to use during the test.
- You may need to have a full bladder. You may
be asked to drink 4 to 6 glasses of liquid, usually juice or water, about an
hour before the test. A full bladder helps transmit sound waves and pushes the
intestines out of the way of the uterus. This makes the ultrasound picture
- You will not be able to urinate until the
test is over. But tell the ultrasound technologist if your bladder is so full
that you are in pain.
- If an ultrasound is done during the later part of
pregnancy, a full bladder may not be needed. The growing fetus will push the
intestines out of the way.
- You will not be able to urinate until the
- You will lie on your back on a padded
examination table. If you become short of breath or lightheaded while lying on
your back, your upper body may be raised or you may be turned on your
- A gel will be spread on your belly.
- A small,
handheld instrument called a transducer will be pressed against the gel on your
skin and moved across your abdomen several times. You may watch the monitor to
see the picture of the fetus during the test.
When the test is finished, the gel is cleaned off of your
skin. You can urinate as soon as the test is done. Transabdominal ultrasound
takes about 30 to 60 minutes.
Ultrasound technologists are trained
to gather images of your fetus but can’t tell you whether it looks normal or
not. Your health professional will share this information with you after the
ultrasound images have been reviewed by a radiologist or
How It Feels
Lying on your back (or side) during the
test may be uncomfortable. During a fetal ultrasound, you may have a feeling of
pressure in your bladder. The gel may feel cool when it is first applied to
your stomach. You will feel a light pressure from the transducer as it passes
over your abdomen.
There is very little chance of either the mother
or the baby having a problem from a biophysical profile (BPP). But you may feel
anxious if the ultrasound reveals a problem with your pregnancy or baby. A
nonstress test may falsely show distress in a baby that is actually
A biophysical profile (BPP) test measures
the health of your baby (fetus) during pregnancy. The results
are scores on five measurements in a 30-minute observation period. Each measurement has a score of 2 points if normal and 0 points if not normal.
Some BPPs do not include all the measurements. When all five measurements are taken, a score of 8 or 10 points means that your baby is healthy. A score of 6
or 8 points means that you may need to be retested in 12 to 24 hours. A score
of 4 or less may mean the baby is having problems. Further testing will be
|Measurement||Normal (2 points)||Abnormal (0 points)|
2 or more heart rate increases of at least 15 beats per minute. Each increase lasts 15 seconds or more and is seen with movement.
Only 1 heart rate increase is seen, or the heart rate does
1 or more breathing movements last at least 60
Breathing movement lasts less than 60 seconds, or no
3 or more movements of the arms, legs, or body
Less than 3 movements of the arms, legs, or
Arms and legs are usually flexed and the head rests on the
The fetus extends slowly and only returns partway to a
The fetus extends but does not return to a normal
The arms, legs, or spine are extended, or a hand is
|Amniotic fluid volume (amniotic fluid index)||
Not enough amniotic fluid is seen in the uterus.
What Affects the Test
Reasons you may not be able to
have the test or why the results may not be helpful include:
- The baby is in a position that makes doing an
- Being unable to lie still throughout the
procedure, which can cause the picture of your baby to be
- Being overweight, which may make it hard to correctly
position the external monitoring device.
- An infection in either you
or your baby.
- Low (hypoglycemia) or high (hyperglycemia) blood
- Taking medicine, such as magnesium
- Steroids given to help the baby’s lungs
- Using alcohol or illegal drugs, such as
- In rare cases, stool (feces) or air in the intestines or
rectum interfering with the fetal ultrasound.
What To Think About
- A biophysical profile includes a nonstress test
with electronic fetal heart monitoring and a fetal ultrasound.
- More tests, such
as a contraction stress test, may be recommended if your results are not
normal. To learn more, see the topic
Contraction Stress Test.
- If there is a
chance that you or your baby may have problems during your pregnancy, you may
have a biophysical profile test every week or twice a week during the last 12
weeks of your pregnancy. Your chances of having problems may be higher if you
- Certain medical conditions, such as
high blood pressure, kidney disease,
- A history of a
stillbirth or preeclampsia.
- A history of
- A history of early
premature rupture of membranes (PROM), or
- A baby who seems small
for the length of the pregnancy or is not growing (intrauterine growth
retardation or restriction).
- Certain medical conditions, such as
- A biophysical profile may be done after an
injury, such as a car crash or fall. Your doctor may recommend more BPP
tests during the rest of your pregnancy.
Other Places To Get Help
- Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
- American College of Obstetricians and Gynecologists (2009, reaffirmed 2014). Ultrasonography in pregnancy. ACOG Practice Bulletin No. 101. Obstetrics and Gynecology, 113(2): 451-461.
Other Works Consulted
- American College of Obstetricians and Gynecologists (1999, reaffirmed 2009). Antepartum fetal surveillance. ACOG Practice Bulletin No. 9. Obstetrics and Gynecology, 94(4): 1-11.
- Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
- Pagana KD, Pagana TJ (2014). Mosby’s Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer William Gilbert, MD – Maternal and Fetal Medicine
Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology
Current as ofMarch 16, 2017
Current as of:
March 16, 2017