Cure bfp published fields are marked. Reasons and procedure for conducting a fetal biophysical profile study. Risks and what can interfere with BPP

Ultrasound examination (echography, scanning) is the only highly informative, safe non-invasive method that allows dynamic monitoring of the fetus’s condition from the very beginning. early stages its development.

DOPPLEROGRAPHY

IN last years Dopplerography, along with cardiotocography (CTG), has become one of the leading research methods in obstetrics, as it allows one to assess the functional state of the fetus.

CARDIOTOCOGRAPHY The purpose of cardiac monitoring is timely diagnosis disturbances in the functional state of the fetus. This allows you to choose adequate tactics therapeutic measures, as well as the optimal timing and method of delivery.

DETERMINATION OF THE BIOPHYSICAL PROFILE OF THE FRUIT

Currently for evaluation intrauterine condition The so-called fetal biophysical profile is used. Determining the biophysical profile of the fetus to obtain objective information is possible from the beginning of the third trimester of pregnancy.

The concept of “biophysical profile of the fetus” includes data from a non-stress test (with CTG) and indicators determined by ultrasound scanning: fetal respiratory movements, physical activity, fetal tone, volume of OB, degree of maturity of the placenta. Each parameter is scored from 0 (pathology) to 2 (normal). The points are summed up and an indicator of the fetal condition is obtained (Table 11-6). A score of 8–12 indicates the normal condition of the fetus. A fetal biophysical profile score of 6–7 points indicates a questionable condition of the fetus. A score of 4–5 or less is an indicator of severe fetal hypoxia and a high risk of developing perinatal complications.

The high sensitivity and specificity of the biophysical profile of the fetus is explained by a combination of markers of acute (non-stress test, respiratory movements, motor activity and fetal tone) and chronic (volume of amniotic fluid, degree of placental maturity) impairment of the fetal condition. A reactive non-stress test, even without additional data, is an indicator of a satisfactory condition of the fetus, while in the presence of a non-reactive non-stress test special meaning acquires ultrasound of other biophysical parameters of the fetus.

2. Premature birth. Etiology. Features of the course and management of premature birth. The effect of prematurity on the fetus and newborn.

All risk factors miscarriages are divided into 4 groups: 1) social-biological causes (age, occupation, bad habits, living conditions); 2) obstetric-gynecological history (character of the menstrual cycle, outcomes of previous pregnancies and births, gynecological obstetrics, uterine malformations); 3) extragenitis of the kidneys (acute inf during treatment, heart defects, hypertension, kidney disease, diabetes); 4) we take complications from the present (severe OPG-gestosis, Rh sensitization, polyhydramnios, multiple pregnancies, placenta previa). Clinical picture. According to the wedge of premature labor, labor is divided into threatening, incipient, and incipient.

Threatened premature birth is characterized by pain in the lower abdomen or lower back. Sometimes there are no complaints at all. Palpation of the uterus reveals increased tone and excitability. The fetal heartbeat is not affected. When examined, no changes are found on the part of the cervix.

When labor begins prematurely, the pain intensifies and becomes cramping in nature. Moisture examination revealed a shortened or smoothed cervix. Often there is an effusion amniotic fluid. The onset of premature labor is characterized by regular contractions. The dilation of the cervix is ​​4 cm or more, which indicates the irreversibility of the process of termination of pregnancy.

Diagnostics. The diagnosis of preterm birth is not difficult. It is based on complaints and external and internal obstetric examination data. The results of the wedge examination are confirmed by hysterography data.

Maintaining. The tactics for managing preterm labor depend on: 1) the stage of the course (threatening, beginning, beginning); 2) gestational age; 3) mother’s condition (somatic diseases, late gestosis); 4) fetal conditions (fetal hypoxia, fetal malformations); 5) state of the amniotic sac (intact, ruptured); 6) degree of cervical dilatation (up to 4 cm, more than 4 cm); 7) the presence and intensity of bleeding; 8) presence or absence of infection.

Depending on the current obstetric situation, conservative or active tactics are followed.

*Conservative tactics (prolongation of pregnancy) are indicated for threatening or beginning labor for up to 36 weeks, an intact amniotic sac, opening of the pharynx up to 4 cm, good fetal condition, in the absence of severe obstetric and somatic pathology and signs of infection.

The complex of treatment for threatened and beginning premature labor includes: 1) bed rest; 2) a light, vitamin-rich diet; 3) medications; 4) physical therapy; 5) reflexology and psychotherapy. Pregnant women are prescribed valerian and motherwort, tazepam, sibazon, seduxen. Antispasmodics (metacin, no-spa, papaverine), antiprostaglandins (indomethacin), calcium antagonists (isoptin) are used.

Women with impending and premature labor due to rupture of amniotic fluid. In the absence of infection, good condition of the mother and fetus and a gestational age of 28-34 weeks, we can prolong the period, strictly observing all the rules of asepsis and antiseptics (sterile pads, disinfection of the external genitalia, insertion of suppositories or antibacterial tablets into the vagina). It is necessary to exercise strict control over identifying the first signs of infection of the birth canal (thermometry, blood tests, bacterial examination of vaginal discharge). If signs of infection appear, labor induction therapy is prescribed.

*Active tactics of threatening and initiating labor are carried out in case of severe somatic illnesses, severe gestosis, fetal hypoxia, fetal malformations and death, signs of infection.

Once premature labor begins, it is carried out through the natural birth canal under constant cardiac monitoring. Premature birth requires special care. It is necessary to widely use antispasmodics and apply adequate pain relief without narcotic drugs. Regulation labor activity if it is violated, it must be carried out carefully. Weakness of labor is corrected by intravenous administration of prostaglandins or oxytocin under careful monitoring of cardiotocography.

Premature birth is often complicated by a rapid or rapid course. A wire is required for professional fetal hypoxia.

In the afterbirth period, a professional blood test is carried out.

Delivery by caesarean section at premature birth carried out according to strict indications: placenta previa, premature abruption of a normally located placenta, eclampsia, transverse position of the fetus.

A child born prematurely has signs of immaturity, so primary treatment and all treatment measures should be carried out in an incubator.

Assessment of the preterm newborn. The birth of a fetus before 28 weeks, regardless of whether the fetus showed signs of life or not, is considered a miscarriage. If the fetus has lived for 7 days, then it is transferred to the group of live births born during premature birth.

It is customary to distinguish 4 degrees of prematurity in children depending on body weight at birth: I degree of prematurity - 2500-2001 g; II- 2000-1501; III- 1500-1001 g; IV - 1000 g or less.

Appearance The premature baby is unique: the body is disproportionate, the lower limbs and neck are short, the umbilical ring is located low, the head is relatively large. The bones of the skull are pliable, the sutures and the small (posterior) fontanel are open. The ears are soft. There is abundant growth of vellus hair on the skin of the back, in the shoulder area, on the forehead, cheeks and thighs. The skin is thin: physiological erythema is clearly expressed. The subcutaneous fat layer is thinned or absent, remaining only in the cheek area. Nails do not reach fingertips. The genital slit in girls gapes because the labia majora do not cover the labia minora. In boys, the testicles have not descended into the scrotum.

Premature babies have functional features: they are characterized by lethargy, drowsiness, decreased muscle tone, weak cry, underdevelopment or absence of the swallowing or sucking reflex, imperfect thermoregulation.

Both newborns and premature babies are assessed one minute and again 5 and 10 minutes after birth using the Apgar scale. In addition, the Silverman-Andersen scale has been proposed for diagnosing and assessing the severity of syndrome disorders in premature newborns. Assessment using this scale is carried out over time every 6 hours after birth for 1-2 days.

Ticket number 32.

Biophysical profile of the fetus is a comprehensive assessment of data from a stress-free test and ultrasound in real time, allowing one to judge the condition of the fetus.

The biophysical profile of the fetus includes five parameters, assessed on a two-point system. A score of 6 or more points is considered satisfactory. Sometimes a 6th parameter is added - placenta maturity.

1. Breathing movements. The fetus makes respiratory movements sporadically: several movements occur in a row, then a break follows. Normally, at least one episode of respiratory movements lasting 30 seconds is recorded within 30 minutes.
2. Fetal movements. The fetus must make at least three pronounced movements within 30 minutes (simultaneous movements of the limbs and torso are considered one movement).
3. Fetal tone - at least one episode of movement of the limbs from a flexion to an extended position and a rapid return to the original state (within 30 minutes).
4. Fetal reactivity (stress-free test) - the presence of two or more periods of heart rate acceleration with an amplitude of at least 15/min and a duration of at least 15 s, associated with fetal movement, during a 10-20-minute observation.
5. Estimation of the amount of amniotic fluid. If there is a sufficient amount of amniotic fluid, a column of amniotic fluid (a section of amniotic fluid free from parts of the fetus and umbilical cord) of at least 2 cm should be visualized in two mutually perpendicular sections in most of the uterine cavity.

Hypoxia. With increasing hypoxemia, progressive inhibition of the biophysical functions of the fetus begins. Changes in some parameters (respiratory movements, motor tone and reactivity) occur immediately after an episode of asphyxia, while changes in other parameters, for example, the amount of amniotic fluid, require more time; such parameters change during chronic hypoxia.

1. Acute hypoxia

• The fetal breathing movements are the first to stop
• Then the stress-free test becomes non-reactive
• The third change is the disappearance of fetal motor activity
• Lastly, the tone of the fetus disappears.

2. With chronic hypoxia, the volume of amniotic fluid decreases over several days or weeks.

Fetal biophysical profiling is used in some clinics as the primary antenatal examination, while in others it is used only when the contractile stress test is positive or inconclusive. For example, the biophysical profile of the fetus is determined in the case of premature rupture of amniotic fluid. With the development of chorioamnionitis, complicating premature rupture of membranes, the biophysical profile of the fetus is rarely satisfactory. In addition, with chorioamnionitis, the reactivity of the stress-free test disappears.

Ultrasonic devices , working in real time, allow not only to assess the anatomical features of the fetus, but also to obtain sufficient full information about its functional state. Currently, the so-called biophysical profile of the fetus(BFPP). Most authors include 6 parameters in this concept: non-stress test (NST) at cardiotocography and 5 indicators determined by ultrasound scanning in real time; fetal breathing movements (DDP); motor activity (YES); tone (T) fruit; volume of amniotic fluid (OOV); degree of maturity of the placenta (SZP). The maximum score is 12 points. The high sensitivity and specificity of BPPP are explained by a combination of markers of acute (NST, DD, DA and T of the fetus) and chronic (FLE, FFP) fetal impairment (Table). Reactive NST, even without additional data, is an indicator of the satisfactory condition of the fetus, while in the presence of non-reactive NST, it becomes especially important ultrasonography other biophysical parameters of the fetus.

Table: Criteria for assessing biophysical parameters

A score of 12-8 indicates the normal condition of the fetus. BPPP assessment 7-6 points indicates a questionable condition of the fetus and possibility of complications. A score of 5-4 or less indicates the presence severe intrauterine fetal hypoxia and high risk of developing perinatal complications.

Determining DFPP to obtain objective information is possible from the beginning of the third trimester of pregnancy.

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Biophysical profile of the fetus is a comprehensive assessment of the data from a stress-free test and ultrasound in real time, allowing one to judge the condition of the fetus. The biophysical profile of the fetus includes five parameters, assessed on a two-point system. A score of 6 or more points is considered satisfactory.

1 . Respiratory movement. The fetus makes respiratory movements sporadically: several movements occur in a row, then a break follows. Normally, at least one episode of respiratory movements lasting 30 seconds is recorded within 30 minutes.

2 . Movements fetus. The fetus must make at least three pronounced movements within 30 minutes (simultaneous movements of the limbs and torso are considered one movement).

3 . Tone fetus- at least one episode of movement of the limbs from a flexion to an extended position and a rapid return to the original state (within 30 minutes).

4 . Reactivity fetus(stress-free test) - the presence of two or more periods of heart rate acceleration with an amplitude of at least 15/min and a duration of at least 15 s, associated with fetal movement, during a 10-20-minute observation.

5 . Grade quantities amniotic water. If there is a sufficient amount of amniotic fluid, a column of amniotic fluid (a section of amniotic fluid free from parts of the fetus and umbilical cord) of at least 2 cm should be visualized in two mutually perpendicular sections in most of the uterine cavity.

Rh-isoimmunization

The body synthesizes antibodies in response to erythrocyte Ags that are foreign to it. In approximately 97% of cases, hemolytic disease of the fetus and newborn is caused by isoimmunization of the pregnant Ag system Rh and AB0. Much less frequently, hemolytic disease of the fetus and newborn occurs due to incompatibility with other erythrocyte Ags (for example, Kell, Duffy, Kidd). Rh isoimmunization is a humoral immune response to fetal erythrocyte Ags of the Rh group, including Cc, Dd and Ee (encoded by Rh alleles). The resulting antibodies, penetrating the placenta, cause hemolysis of erythrocytes (opsonization of fetal erythrocytes by the woman's antibodies and phagocytosis of erythrocytes) and anemia, leading to the development of fetal erythroblastosis. All Rh-Ags located on the erythrocyte membrane stimulate the synthesis of IgG class antibodies in the pregnant woman’s body.

 Frequency. 1.5% of all pregnancies are complicated by sensitization of fetal erythrocyte Ags. The incidence of Rh isoimmunization has decreased significantly with the use of Rh 0 -(anti-D)-Ig.

 Epidemiology. There is a dependence of the distribution of Rh-Ag on race. Thus, almost all American Indians and Asians (99%) have Rh-positive blood.

During the initial penetration of foreign Ag, the body synthesizes IgM (19s-Ig). Sensitization by erythrocyte Ags can occur during childbirth (the entry of umbilical cord blood into the mother’s bloodstream) or during gestation (a small intake of fetal blood through the placenta is considered normal). With subsequent exposure to Ag, IgG (7s-Ig) is synthesized as a result of a secondary immune response. Other Igs (IgE, IgD, IgA) are also synthesized in response to foreign Ags, but only IgG, due to its small size, is able to penetrate through the placenta to the fetus.

AB0-incompatibility softens the course of pregnancy during Rh conflict. Rh conflict occurs more often if the pregnant woman and the fetus have the same or compatible blood groups according to the ABO system. In case of incompatibility according to the ABO system, fetal red blood cells, entering the pregnant woman’s body, are quickly destroyed, so anti-Rh-ATs do not have time to be synthesized.

The maturation of the nervous system leads to the formation in the fetus of a clear change in periods of sleep and wakefulness, which become distinguishable by the 20th week of pregnancy. After this period, the gynecologist can send the woman to study the biophysical profile of the fetus. In what cases is this test carried out and how to decipher it?

What is the biophysical profile of the fetus?

Fetal biophysical profile (FPP) is a summary assessment of CTG examination and ultrasound monitoring of the intrauterine state of the child.

Ultrasound examination is carried out in real time. During an ultrasound, the amount of amniotic fluid is assessed and Various types baby's movements.

The CTG method records fetal heart rate variability. Transcript from a cardiologist.

Indications for research

Determination of the biophysical profile of the fetus is carried out in the third trimester of pregnancy. It is prescribed to women with post-term pregnancy, as well as later in the presence of the following indications:

• delay intrauterine development fetus according to ultrasound data;
• diabetes mellitus, gestational diabetes, arterial hypertension and other chronic diseases that affect the course of pregnancy;
• oligohydramnios or polyhydramnios;
• decreased activity of the child;
• post-term pregnancy;
• a history of late miscarriages of unknown etiology.

Determination of the biophysical profile of the fetus

By week 28, the fetus has fully formed a system of reactions to external influences. From now on, the biophysical profile, also called the fetal well-being test, becomes informative.

Determining the BPP takes at least 40 minutes. During this time, the pregnant woman undergoes cardiotocography and ultrasound. To stimulate the child a little, you need to eat before the procedure.

For BPP, the results of a non-stress test are required. The norm is the acceleration of the number of heart beats after the child’s own movements. If there are signs of cardiac depression, the heart rate will remain unchanged or, on the contrary, slow down. For conducting CTG a sensor is used to determine the tone of the uterus. It is placed on the stomach above the navel, shifted to the right corner of the uterus.

The second sensor is placed in the projection of the fetal back; it records the heart rate. The woman is given a special button in her hand, which she presses when movement occurs. Recording duration is 20 minutes.

Fetal heart rate is extremely important:

• The work of the kidneys depends on heart contractions. Decreased urine output leads to a decrease in the amount of amniotic fluid.
• Heart rate may indicate oxygen starvation, which, under various pathological conditions leads to acidosis, which depresses the nervous system and cardiac activity.

Ultrasound is performed continuously for 30 minutes. If all indicators are recorded as normal, then the time is reduced. During an ultrasound, the doctor evaluates:

• Breathing movement chest- they are impermanent, appearing and disappearing spontaneously. An episode is the moment from the beginning to the end of respiratory movements. Normally it is at least 60 s per half hour.
• Flexion or extension movements of the torso or limbs - tone is assessed by them. If the neck, arms or legs are in an extended position, this is considered abnormal and may indicate serious problems, including antenatal death.
• Motor activity, that is, any movement, displacement, rotation of the torso, arms or legs. Their total number during the study is calculated.
• The volume of amniotic fluid - it reflects the metabolic state of the fetus.
• The degree of maturity of the placenta - indicates possible reasons hypoxia.

Decoding the BPP

The severity of each indicator is assessed in points from 0 to 2. The norm of the biophysical profile of the fetus indicates the absence of risk.

Non-stress test:

• 2 points if there were 5 episodes of heart rate acceleration in response to movement lasting 15 seconds or more. force of at least 15 blows;
• 1 point is given for 2-4 such episodes;
• episode - 0 points.

Breathing movements:

• receive the maximum rating if there were 1 or more episodes lasting 60 seconds or more;
• periods 30-60 sec. get 1 point;
• absence or breathing for less than 30 seconds. - 0 points.

Motor movements:

• 3 or more motor movements - 2 points;
• for 1-2 movements they give 1 point;
• 0 if there is no movement.

Flexion or extension movements:

• Considered normal muscle tone, in which at least one episode of flexion-extension of the limb and back is recorded, 2 points are given for it.
• A point is given if one of the listed episodes is present.
• Stable extension, open palms - 0 points.

Amniotic fluid:

• must be in all pockets, depth 2 cm;
• pockets 1-2 cm are scored 1 point;
• less than 1 cm - 0 points.

Degree of maturity of the placenta:

• 2 points are given for 0, 1, 2 degrees of placental maturity;
• if its visualization is difficult, give 1 point;
• aging placenta grade 4 is scored 0 points.

The received scores are summed up:

• The maximum possible amount is 12 points. A biophysical profile of the fetus of 8 and 9 points is also considered normal.
• A result of 6-7 is considered doubtful. It requires additional observation and examination. A woman may be offered hospitalization in the pregnancy pathology department at the maternity hospital.
• A score of 5 or less indicates deep suffering of the fetus, which can lead to its death.

In the latter case, after the ultrasound room, the woman is urgently sent to hospital by her obstetrician-gynecologist. In difficult situations, early delivery by cesarean section is performed to save the child’s life.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

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