What Is a Biophysical Profile?

A biophysical profile (BPP) is a prenatal ultrasound that uses a scoring system to assess the health of your baby during pregnancy. It is most likely to be completed in the third trimester for women who have a high-risk pregnancy or if there’s a chance for complications.

If your doctor recommends one, know that BPP testing is considered safe and non-invasive. It utilizes a non-stress test to evaluate the baby’s heartbeat and ultrasound technology to view the amniotic fluid and the baby’s movements, muscle tone, and breathing patterns. Each of these areas is given a number ranging from zero to two, with a possible, combined score of 10 points, reports The American College of Obstetrics and Gynecology (ACOG). The average BPP may last anywhere from 30 minutes to over an hour.

Purpose of Test

During pregnancy, both the health of the mother and the baby are crucial to maximize the potential for successful delivery and minimize complications. One way to determine the well-being of the baby is through BPP. Some of the reasons your doctor may choose to use this technology, according to the University of Michigan Medical School, include:

• Evaluating the baby’s health, especially if you have a history of complications with previous pregnancies or your baby is two weeks past the expected due date
• You’re expected to deliver more than one baby (twins, triplets, etc.)
• Pregnancy-related health conditions like preeclampsia or unexplained bleeding
• You have pre-existing health conditions like hyperthyroidism, lupus, high blood pressure, type 1 diabetes or gestational diabetes that develops during pregnancy, or chronic kidney disease
• You have too much or too little amniotic fluid

Please note: There are other illnesses and health conditions that can occur in the mother or baby that may require a BPP, but these are the most common.

Limitations

BBP is not 100 percent foolproof—potentially, the test could miss a problem with the health of the baby, or it could falsely indicate there’s an issue when there may not be, which could result in additional, and sometimes unnecessary, testing.

However, the false positive rates are considered low with this method of testing. A BPP could be limited in that it may not be able to predict or change the outcome of a pregnancy.

Risks and Complications

BPP doesn’t involve the use of radiation and isn’t considered invasive. Since it electrically monitors the baby’s heart rate and uses sound waves to create images, it does not pose a health risk to you or your baby.

The American Pregnancy Association notes that there may be some cause for concern when an ultrasound is done for an extended period of time, but no further details were provided regarding those areas of concern. If you’re uncertain about the length of time your BPP will last, be sure to talk with your doctor before beginning the procedure so that you can make an informed decision about moving forward in the best interest of you and your baby. If there are risks for your particular situation, your doctor can help you weigh the pros and cons of receiving this test.

Before the Test

BPP requires relatively little preparation, so you may have your test on the same day as your doctor’s appointment or a different day. Before the test, the doctor will ask you about your health history—be sure to note any health conditions you’ve been diagnosed with. Also, let your doctor know if you smoke, as this may dictate the timeframe you’re required to wait before having the test. Additionally, your doctor will let you know if there are specific instructions you need to follow before having your BPP.

You may also use the time before the test as an opportunity to ask any questions regarding the procedure that might be on your mind.

Timing

If your healthcare provider completes the full BPP, the test may take anywhere from 30 minutes to just over an hour. If your practitioner decides a modified BPP is the best approach to evaluating the health of your baby, the procedure may take as little as 20 minutes. In many cases, you may be able to find out the results of the test right after it’s finished.

Location

Testing may be done in a hospital, clinic, or doctor’s office. Your obstetrician might perform the test themselves, but other healthcare practitioners, like an ultrasound technician or radiologist, may do it as well.

What to Wear  

There’s no set rule as to the type of clothing you need to wear for the test, however, you may find that you’re more comfortable in loose-fitted clothing that allows you to lie down and gives the healthcare provider access to your abdomen. In some situations, you may be asked to put on a gown.

Food and Drink

Generally, you can continue with your regular food and drink routine, but your doctor may give you specific instruction if need be. For example, you may be asked to drink liquids so that your bladder is full during the test. But the particular instructions may vary from person to person.

Also, if you smoke, you’ll be asked to refrain from smoking for at least two hours before the test — smoking may impact the baby’s activity level.  

Other Considerations

When you show up for the test, bring your insurance card and any paperwork you’ve been asked to fill out. If you must schedule the test for a day or location other than when you have your doctor’s appointment, keep in mind you may encounter a waiting period. You might find that your wait time is more tolerable if you bring something to do, like reading a book or magazine, to occupy your time. Since BPP is a non-invasive test, you’re not required to have someone else drive you to and from the appointment, but you may feel more at ease having your spouse, partner, friend, or family member with you.

During the Test

The test will involve two components—the non-stress test portion and an ultrasound. Throughout the test, you’ll lie on a padded table with your belly exposed. Sometimes you may be asked to change into a gown, but usually, you can keep your clothes on and just expose your belly. Be sure to let your healthcare provider know if you’re uncomfortable, so they can place you in a position that’s more tolerable.

Throughout the Test

When you undergo the non-stress test, a belt measuring the baby’s heart rate will be placed across your belly and recorded. Sometimes your baby may be sleeping, so the healthcare provider may decide to wait until your baby wakes up to continue the test. In other cases, the healthcare provider may attempt to arouse the baby gently.

The next portion of the test involves the ultrasound, where the baby’s breathing patterns, movements, muscle tone, and amniotic fluid volume will be evaluated. Here, your healthcare provider will apply a gel-like substance to your abdomen and place a small machine (a transducer) over your belly to obtain images of the baby.

After the Test  

Once the test is finished, your healthcare provider will wipe the gel off your abdomen and give you time to get dressed. You may or may not receive the results the same day. Typically, you’ll be allowed to go home, and your doctor will notify you if you need to make arrangements for additional testing or appointments. BPP is not known to cause side effects for a mother or baby.

Interpreting the Results

The University of Michigan Medical Centers explains that the BPP measures five areas of your baby's health (heart rate, breathing, movement, muscle tone, and amniotic fluid) on a numeric scale of zero to two. When the scores are combined, results indicate the following:

• A total of eight to 10 indicates that your baby is healthy
• A point-total of six to eight will require you to have the test repeated in 12 to 24 hours
• If the score is four or less, this indicates the baby is having problems, and further testing will be necessary to identify the challenges the baby may be facing

In most cases the results will be ready right after the test is completed. Whether it’s a routine exam or additional testing, your doctor will provide you with appropriate follow-up instructions.

A Word From Verywell

For many people, the testing process, from the waiting room to the test results, can provoke anxiety, especially when you’re waiting to hear about the health of your baby. To ease the process a bit, make sure you’re working with a physician with whom you feel you can openly communicate your worries and ask any pressing questions you may have. Communication is vital to a successful doctor-patient relationship.