SKOR BISHOP

REFERENSI:

Achadiat, Chrisdiono M. 2004. Prosedur tetap obstetri dan ginekologi. Jakarta: EGC
Biophysical Profile Score (BPS or BPP)
The biophysical profile is a test used to evaluate the well-being of the fetus. The
biophysical profile uses ultrasound and cardiotocography (CTG), also known
electronic fetal heart rate monitoring, to examine the fetus. There are five
components measured during the biophysical examination. A score of 2 points is
given for each component that meets criteria as listed in the table below. The test
is continued until all criteria are met or 30 minutes have elapsed. The points are
then added for a possible maximum score of 10.

Component Normal (2 points) Abnormal (0 points)

One or more episodes of No episodes of fetal breathing
Fetal
fetal breathing lasting at movements lasting at least 30
Breathing
least 30 seconds within seconds during a 30 minute
Movements
30 minutes. period of observation.
3 or more discrete body
Gross Body Less than 3 body or limb
or limb movements within
Movement movements in 30 minutes
30 minutes
One or more episodes of
active extension and Slow extension with no return
flexion of a fetal or slow return to flexion of a
Fetal Tone
extremity OR opening fetal extremity OR no fetal
and closing of the hand movement
within 30 minutes
A single deepest vertical A single deepest vertical
Amniotic
pocket of amniotic fluid pocket of amniotic fluid
Fluid
measures greater than 2 measures 2 centimeters or
Volume *
centimeters. is present less
Non-stress
test Reactive Nonreactive
(NST)**
*Amniotic Fluid Volume Measured as the vertical measurement, in centimeters, of
the single deepest pocket of amniotic fluid with a transverse measurement of 1 cm
or more wide without fetal small parts or umbilical cord. [2]
** Reactive Two or more fetal heart rate accelerations that peak (but do not
necessarily remain) at least 15 beats per minute above the baseline and last at least
15 seconds from baseline to baseline during 20 minutes of observation
**Nonreactive Less than two accelerations of fetal heart rate as described above
after 40 minutes of observation [1]

Biophysical Profile Test Score Results

A total score of 10 out of 10 or 8 out of 10 with normal fluid is considered

normal. A score of 6 is considered equivocal, and a score of 4 or less is
abnormal [1, 3, 6]. A score of less than 8 indicates the fetus may not be
receiving enough oxygen. However, decreased biophysical activities may
also be seen for a brief time in the preterm fetus after treatment with ether
betamethasone or dexamethasone given to enhance fetal lung maturity [7].
 Management
Test Score
ACOG [1] SOGC [6]
10 out of 10 , 8
out of 10 (normal Deliver for obstetric or maternal
fluid), 8 out of 10 factors
(NST not done)
If there is normal urinary tract
Uncomplicated, isolated function and intact membranes
8 out of 10
persistent oligohydramnios then deliver at term. If < 34
(abnormal fluid)
deliver at 36 to 37 weeks. weeks intensive surveillance to
maximize maturity
6 out of 10 At or beyond 37 0/7 weeks of
Repeat test within 24 hours
(normal fluid) gestation, further evaluation
and consideration of delivery.
Deliver if at term .If < 34 weeks
6 out of 10 Less than 37 0/7
intensive surveillance to
(abnormal fluid) weeks repeat BPP in 24
hours maximize maturity
Delivery is usually indicated.
Pregnancies at less than 32
0/7 weeks of gestation,
4 out of 10 management should be Deliver
individualized, and extended
monitoring may be
appropriate.
2 out of 10 Deliver Deliver
0 out of 10 Deliver Deliver

The Modified Biophysical Profile (MBPP)

Some testing centers use a modified biophysical profile [4, 5]. The modified
BPP consists of the nonstress test (NST) and an amniotic fluid volume
assessment. The modified BPP is considered normal if the NST is reactive
and the deepest vertical pocket of amniotic fluid is greater than 2
centimeters. The modified BPP is considered abnormal if either the NST is
nonreactive or the deepest vertical pocket of amniotic fluid is 2 cm or less
[1].

When is the MBPP or BPP Usually Performed?

The modified BPP may be performed for decreased fetal movement. If the
NST is nonreactive or the amniotic fluid volume is low a full BPP is usually
done.

ACOG recommends the MBPP or BPP may also be used for antepartum
fetal surveillance in pregnancies at increased risk for bad perinatal outcomes
including , but not limited to, pregnancies complicated by hypertension,
preeclampsia, pregestational diabetes, poorly controlled or medically treated
gestational diabetes, poorly controlled hyperthyroidism, chronic renal
disease, systemic lupus erythematosus, antiphospholipid syndrome,
hemoglobinopathy (sickle cell disease) , maternal cyanotic heart disease,
moderate or severe asthma during
pregnancy, isoimmunization, oligohydramnios, unexplained or recurrent
risk for stillbirth, fetal growth restriction , and late term pregnancy at or
beyond 41 0/7 weeks [1, 9,10].

The Society of Obstetricians and Gynaecologists of Canada (SOGC)

suggests antenatal fetal surveillance may also be beneficial in pregnancies
complicated by preterm premature rupture of membranes, chronic (stable
abruption), vaginal bleeding, abnormal maternal serum screening in the
absence of confirmed fetal anomaly, motor vehicle accident during
pregnancy, morbid obesity, advanced maternal age, assisted reproductive
technologies, multiple pregnancy, polyhydramnios, and preterm labor [6].

In addition to many of the above indications an executive summary by a

Eunice Kennedy Shriver National Institute of Child Health and Human
Development workshop on antenatal testing suggested antepartum testing
for cholestasis of pregnancy was appropriate. However, the workshop found
insufficient data to recommend antenatal testing for other conditions such
as obesity, advanced maternal age, abnormal maternal serum markers,
thrombophilias, triplets and higher-order multiples [11].

The American College of Obstetricians and Gynecologists has observed that

despite a lack of high quality evidence that antepartum surveillance
decreases the risk of fetal death ..."antepartum fetal surveillance is widely
integrated into clinical practice in the developed world." [1,8]. ACOG advises
"... initiating antepartum fetal testing no earlier than 32 0/7 weeks of gestation
is appropriate for most at-risk patients . However, in pregnancies with
multiple or particularly worrisome high-risk conditions (e.g., chronic
hypertension with suspected fetal growth restriction), testing might begin at
a gestational age when delivery would be considered for perinatal benefit".If
delivery is not planned (eg, given early gestational age), then antenatal
surveillance should not be performed because the results will not inform
management [1].

References

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POST-TERM PREGNANCY SIGNS