Any reason NOT to have the biophysical profile?

lauraliz24

Hello all!  I am with a great midwife group that I trust in general, they almost always leave decisions up to us and respect what we want.  So, I am 40+ weeks and was given the referral for a post-dates biophysical profile with the explanation that anytime a mom goes past her due date it is done to "check on the baby".  I did my research and I believe I understand what they're looking for.  So, my question is, is there a reason that one would NOT get a BPP done, or put if off longer?  I just want to make sure I'm understanding all aspects of the decision.  Thanks so much!

Jdunk2008

This is going to assess fetal well being. Is there some reason you don't want to do it? It is not an invasive procedure. It is very much up to you but if it isn't an invasive thing I'm just wondering why you feel you don't need it?

 

lauraliz24

Jdunk2008:

This is going to assess fetal well being. Is there some reason you don't want to do it? It is not an invasive procedure. It is very much up to you but if it isn't an invasive thing I'm just wondering why you feel you don't need it?

 

No, sorry, I didn't mean to come across as not wanting to get it.  We have an appointment to get it done, I was just wondering if others had perspectives or reasons why it shouldn't be done.  For example, although many providers do cervical checks to "see how things are progressing", they really don't need to be done because the information isn't all that useful.  I mean, if the fluid level is a little low, is that super serious, or can I safely go another week without concern.  Maybe this is too much of a medical question for the boards.  Just thought maybe someone would have some insight.

Jdunk2008

No, it is a good question. I am a nurse and work in the Midwest. Fluid levels is one thing they will check for sure, another thing they will check is fetal movement, and heart rate. While a heart rate is a good thing, they are looking at other things about the heart rate. You might hear them say there are good "accels" or "variability". These are movements in the heartrate. One reason people end up being induced is because they get to a point where they are considered to be in post dates range. Your placenta is doing all it can for your baby but after 40 plus weeks it will start to wear out. It won't be as affective for your baby. This isn't a huge concern because you will likely go into labor or be induced but it is something to think about. Hope this helps!

This is from ACOG:

BIOPHYSICAL PROFILE

The biophysical profile discussed in the ACOG bulletin is a nonstress test plus four observations made by real-time ultrasonography. The five components of the biophysical profile are as follows: (1) nonstress test; (2) fetal breathing movements (one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes); (3) fetal movement (three or more discrete body or limb movements within 30 minutes); (4) fetal tone (one or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand; and (5) determination of the amniotic fluid volume (a single vertical pocket of amniotic fluid exceeding 2 cm is considered evidence of adequate amniotic fluid).

Each of the components is given a score of 2 (normal or present as defined previously) or 0 (abnormal, absent or insufficient). A composite score of 8 or 10 is normal, a score of 6 is equivocal and a score of 4 or less is abnormal. In the presence of oligohydramnios, further evaluation is warranted regardless of the composite score.

AmyRI

I would not turn down a BPP if requested. I would, however, verify that they are not intending to also do a size estimate that, if it went poorly, would turn into ammunition for induction despite the large errors associated with such measurements. So long as they stick with the ACOG definition, I don't see the harm - and if something came up, it would be a concern and I'd be willing to talk about induction.

meltoine

I agree with AmyRI. You're absolutely right that cervical checks tell you nothing, beta BPP tells you lots of good info. You can know if you fluid levels are low (make sure you are well-hydrated before you go) and they will check your placental function too. The placenta does begin to deteriorate eventually and that is one of the main risks of going to 42 weeks or beyond. It's rare, but worth looking for. 

We wary of any recommendations given to you by the person conducting the BPP and discuss the results thoroughly with your midwife when you get them. It wouldn't be uncommon for the doctor doing the exam to recommend immediate induction, but give your midwife the scientific evidence and see what she thinks before you get upset.  

nosoup4u

I had BPP done with  my first son when I went past 41 weeks. Lo and behold, I had "low amniotic fluid" (though I was actually on the low end of the range of normal), and was flagged for more BPPs. DS1 and I were both totally fine in every other respect. My MW ended up pushing for an induction because of the AFI, but she was overruled by a high-risk OB who said that if we were okay in every other respect, I could just go home and wait for labor to begin (which it did, the next morning). The whole thing was a mess - low AFI alone isn't as risky as my MW was making it out to be, and it caused us a lot of unnecessary worry and stress.

I refused the u/s portion of it when I was pregnant with my second son because of what happened with my first. Even the MW who I talked to when I signed an AMA form refusing it acknowledged that the monitoring alone is an appropriate way of determining the baby's health.

Do what you want, consider your options and what you would do if they recommend an induction or whatever based on the BPP.

jinnymb

I don't believe there is any reason NOT to get the test done.  I had one with DS1 in order to avoid induction.  It showed he was good to go and it got them off my back.  I think it is a good tool to assess the true nature of an "over due" baby and actually back you up and ease your mind into not inducing.  Of course then something is awry then you make an informed decision.