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Biophysical profile

Biophysical profile (BPP) test is a prenatal test performed to monitor the health of the fetus. This test is a combination of fetal ultrasound and a nonstress test i.e. heart rate monitoring of the fetus. The test is performed to measure the certain attributes in an unborn child including:

  • Normal breathing of the fetus i.e. continuous rhythmic breathing cycles.
  • Normal heart rate and increased heart rate while any movements.
  • Muscle tone e.g. flexing and extension of limbs, closing and opening of mouth and hands or rotation of the baby’s trunk, etc.
  • Movements of the fetus
  • The amniotic fluid which protects the fetus

Both the fetus ultrasound and nonstress test are allocated scores, based on whether the test criteria has been met or not. If the score is low on a Biophysical profile, the doctor may advise going for some more tests to get a confirmed diagnosis. The biophysical test is usually performed in the last trimester of pregnancy or after the 32nd week of pregnancy. This test is a very safe and noninvasive and doesn’t have any side effects. There is no risk involved in the biophysical test either to the expectant mother or to the fetus.

Why it's done? What are the risks? How to prepare for the procedure? Expected Results from the Procedure: FAQ Section:

The biophysical test is used to access the fetus well-being.

The doctor may advise a biophysical profile once or twice a week, according to the health of the expectant woman until delivery.

A biophysical profile test is very safe and is a noninvasive procedure, which does not cause any harm to either the mother or the fetus. This test, however, might cause some anxiety which may add to a false-positive result i.e. detecting a problem when there actually is none. They test may also, sometimes, not identify the existing problems, if any. As a result, the doctor has to advise some more pregnancy tests in order to get a confirmed diagnosis.

Before the procedure:

A biophysical profile does not need any special preparations. The doctor or the trained nurse usually explains the procedure in detail to the patient. Some points to be taken into consideration are as mentioned.

  • The bladder of the patient needs to be full.
  • The patient is advised to drink a lot of water or fluids before the test.
  • The patient is advised to refrain from urinating
  • The woman in the third trimester may not require a full bladder.
  • Avoid smoking at least 2 to 3 hours before the test as it lowers the activity of the fetus and is also harmful for the baby's normal growth.
  • Inform the doctor about any specific medications, which are being taken by the patient or about any other medical problems, which the mother might be facing.

During the procedure:

Non-stress Test:

During the test, the patient is asked to change into a hospital gown and is asked to lie down on an examination table on the back. Two belts will be placed across the patient’s abdomen and the blood pressure of the woman would be monitored simultaneously before and even during the procedure.

One of the belts has sensors on it, which will measure the heart rate of the fetus, and the heart rate would be recorded by a machine. The other belt helps in monitoring any uterine contraction. Sometimes, if the fetus is sleeping the results might not be very accurate and hence, the mother needs to wait until the fetus wakes up for correct evaluations. In some cases, the radiologist or the doctor also tries to awaken the fetus by producing sounds on the abdomen of the expectant mother or by asking the woman to drink water or juice.

The woman is asked to press a button when any movements are felt by her in order to capture the movements immediately. The movements of the fetus are recorded normally and also increased heart rate is measured, during the movements, on the electronic fetal heart machine.

Fetal Ultrasound scan:

The person undergoing the abdominal scan is asked to lie down on the back on an examination table so that the abdomen of the patient is exposed. A special clear gel is then applied over the abdominal surface to prevent air between the skin and a small device known as a transducer.

The transducer is moved in the back and forth motion on the abdominal area. The sound waves are sent out through the transducer and the reflections are captured, which forms an image on the monitor. These images are interpreted by the radiologist and a report is prepared which is handed over to the concerned doctor for reviewing the results.

After the procedure:

The overall procedure usually takes approximately 20 to 30 minutes to complete. The woman is allowed to change back into normal clothes after the procedure. The patient is allowed to use the washroom after the procedure is finished and is also allowed to go home and start performing normal routine activities. The patient can eat and drink normally. The report, once available, is discussed in detail with the patient, by the doctor.

The doctor will discuss the report of the patient in detail. All the areas checked during the biophysical profile are allocated a score, based on whether the criteria for the test was met or not. If the score is low on a Biophysical profile, the doctor might advise going for some more tests to get a confirmed diagnosis.

A biophysical profile is either reactive or non-reactive:

  • Reactive – If the Biophysical profile is done before the 32nd week of pregnancy and the heartbeat of the fetus increases twice or more to a certain level and stays increased for at least 10 seconds each time within a set of 20 minutes, the profile is considered normal or reactive.
  • Non-reactive – Results are considered abnormal or non-reactive if the above-mentioned criteria is not met. This may occur if the fetus is asleep during the procedure.

The doctor may advise for some other additional tests in order to get a confirmed diagnosis if the results are not clear.

The various details checked of the fetus during the biophysical test, are allocated a score of either 0 or 2 after the test. The significance of the score is as mentioned.

  • Breathing of the fetus
  • The heart rate of the fetus
  • The muscle tone of the fetus
  • Movement of the fetus
  • Level of amniotic fluid around the fetus

Q1. How frequently the biophysical test should be done?

A1. Generally, the biophysical profile is advised by the doctor in the last trimester or after the 32nd week of pregnancy. However, in some cases, wherein some risks are observed by the doctor, the woman may be advised to get it done in the earlier pregnancy period. Some of the risks cosidered for early test include preeclampsia (a problem of high blood pressure in a woman who have never had increased B.P previously apart from pregnancy), diabetes, asthma (moderate or severe), hypertension, renal disorders, lupus, thrombocytopenia or any major problems which may lead to miscarriage (loss of pregnancy). In such cases, the doctor may also ask for follow-ups for biophysical tests until the delivery.

Q2. Are there any other tests similar to Biophysical profile?

A2. There are some other tests which are similar to the biophysical profile in a way, as mentioned below

  • Prenatal abdominal ultrasound scan
  • Amniotic Fluid Index (AFI)
  • Deep pocket measurement
  • Nonstress test (alone)
  • Amniotic fluid volume assessment



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