BPP+NST

Welcome to the world of medical acronyms! I’m not sure how long this post will turn out, but I’ll try to keep it brief, a) because some of you will be bored and b) because I need to do something else with my time!

So just as an explanation, a non-stress test is (for those of you who have never had/seen one) called such because there is no stress placed on the baby. Literally, that’s the extent of the nomenclature. Stupid, no? Anyway, mom-to-be wears these stylish elastic belts around her belly, which keep in place various tools. In my case, 2 belts kept probes in place that picked up each baby’s heartbeat and graphed it, and 1 belt kept in place what they call a tocometer, which (externally) measures uterine tone — resting vs. contractions. The presumption is that, if the baby is properly oxygenated and the placenta is working well, then the heart will respond a certain way with the baby’s own movements. The test is 20-30 minutes long, and during this time they want to see 2 or more “accelerations” in response to fetal movement (increase in heart rate of at least 15 beats per minute, lasting approximately 15 seconds before the heart rate returns to the baby’s baseline). In this case, the test is called “reactive”. This is what the brain is supposed to signal the heart to do with movement, so reactive = good. Regardless of these accelerations (or, I should say in addition to watching for them), they never want to see decelerations of the heart rate — especially in response to uterine contractions. By definition, which is quite important, a deceleration that “counts” is at least 20-25 beats per minute below the babies baseline, for several seconds at a time.

The biophysical profile test is made up of 5 parts. For each part, the baby can score 2 points (for a “normal” response) or 0 points (for an “abnormal” response). There is no 1 point, no in between. It’s all or nothing, pass or fail for each category :). The categories are as follows:

1) non-stress test results, whereby Reactive = 2 points, Non-Reactive or Inconclusive = 0 points.

The remainder are done by ultrasound exam:
2) amniotic fluid adequacy: They take a measurement (which we have posted about before) called the “largest vertical pocket” of fluid, where >2cm = 2 points, 3) breathing movements: Babies do this thing in utero called “practice breathing”, where their little bellies just go to town as if they were breathing (if only they were in air and could do so). At least one “episode” of breathing movements of 30-60 seconds or more = 2 points. No practice breathing episodes, or sporadic ones that aren’t substantial lengths of time = 0 points.
4) fetal movement: Limbs or body should have 3 distinct sets of movement (a shaking of a fist or something continuous like this would be one movement) in a 30-minute period.
5) fetal tone: babies are generally in a flexed position in utero (chin toward chest, arms and legs tight to their torso. In a 30-minute period, they want to see at least one episode where a limb or head is extended and returned back to this flexed position. Even the opening and closing of a fist counts.

So now that you know as much as I ever learned in OB during nursing school (I always hated pregnancy crap), I’ll brief you on our specifics.

Baby B is a little firecracker, which we’ve known since the very first ultrasound 13+ weeks ago. Her little heart just reacted away with each of her (incredibly frequent) movements. She moved so much during every minute of the ultrasound portion that it was hard to “catch” her heart long enough to track a rate. Limbs kicked, she practiced breathing probably 2-3 times for at least a minute each time. Amniotic fluid was the highest it’s been, even towards the higher end of normal (both babies have been low normal for as long as this has been measured). She passed her BPP very quickly with a score of 10. (FYI, 8-10 is passing with no concerns, 6 is worrisome and requires more testing/monitoring, 4 or less likely means immediate delivery is necessary).

Baby A is testing her mommy and daddy’s strength a bit. This test was to happen next week with our growth check ultrasound, but was moved to today because she hasn’t been moving as much as she used to. This could be totally normal, as she grows bigger and runs out of room to wind up and make a big, fat kick to my ribs. This could also be abnormal, with varying levels of importance. So, my OB just wanted to be safe and put our minds at ease going into the weekend by moving the BPP+NST to this morning. The non-stress test was reactive, although it took quite a while to get any accelerations. This caught me a bit off guard, until I remembered that even non-reactive tests are totally inconclusive because the baby might be sleeping, etc. No movements, and there aren’t even to be any accelerations expected. Still, the cutoffs are laid out above. She had 2-3 appropriate accelerations in about 20-30 minutes. A perfectly acceptable, reactive NST result.

The ultrasound was more frustrating. She is an expert “practice breather”, maybe even the best to ever pass through The Christ Hospital perinatal center. It was practically non-stop, and she looked great! Amniotic fluid is at about 2.5cm, which is exactly where it has been from week 17, which is fine (2-4ish is normal). The girl, however, would not show off her moves no matter how much we begged. She (very adorably, I might add) yawned a ton, flapped her mouth as if she were telling us off, etc… but she must have been very sleepy, because that was the extent of her movements for quite some time. The sonographer busted out “the buzzer” (a cruel device that scares the living crap out of babies when they put it right to their head and make this awful buzzing/vibrating commotion), and used it several times. We walked a lot. We rolled (me) from side to side, sat up, laid back more, etc. Baby A would yawn a bit more as if we were totally bothering her, and then do nothing. Almost 40 minutes passed, when finally she sort of tossed and turned, moving her torso what I would consider one time, knowing that the motions are supposed to be distinct motion sets, with continuous motions counting as one.

And yet…. the sonographer said “oh, she’s moving”, gave her a 2 and told the perinatologist both babies passed. There was no flexion and extension, and I wasn’t totally satisfied with the fetal movement in general. By my calculations, she more likely got a 6/10. I don’t see how she could have possibly been given a 2 for movement when she moved one time, and it took 40 minutes for that. We didn’t continue watching for any additional movements, or to see if – once she finally got going – she would have had enough, in a short enough time frame. And she obviously didn’t have any extension and flexion, since she hardly moved a muscle! Extra credit is cool and all, when you’re trying to get a student to pass a math test. Being generous (EXTREMELY generous) with scores on a biophysical profile is not so cool.

After I left, I immediately called my OB office to make sure they heard my concerns. I got a return phone call assuring me that they get “detailed” results (God forbid their results say “Baby A scored 8, Baby B scored 10” with no further details. This was my greatest fear!). The nurse said she is making a note that it took so much to get my sluggish girl moving, and that I am still uneasy with the so-called results. She assured me that they will repeat the testing as necessary, and that she understands my concerns. I told her that I am trying to keep in mind that the perinatologist, of all professions, will not blow things off that seem poor. At the same time, though, he wasn’t in there for the BPP. All he heard was “both babies passed”, as he hardly paid attention to the NST since they “passed” even without it (supposedly).

I want to believe that all is well, and that I just have a super laid-back girl (lazy?). Still, next Tuesday’s ultrasound can’t come quick enough. While it’s supposed to just be a growth check (15 minutes of quick measurements), I think we’re going to insist that they linger a while on Baby A. If she could just throw out a few good punches and kicks while we’re watching, we will be infinitely less concerned.

Oh, and just for fun, my uterus let out several mild contractions and about 3 “moderate” ones during the 20-30 minute non-stress test. Awesome.

I will keep you up to date when we go for more testing. For now, I’m going to get the heck off of the internet — and hopefully take a nap!

Comments

  1. thanks for the detailed info. i know i never learned all of that in nursing school. i will pray for the girls as always. remember that troy was climbing stairs at age 6 months and i could not keep him in a crib past 11 months. kelly never got out of the crib in 2 years, she just started talking at 8 months and would wake up and just start calling out orders…”mom, get up!. i am hungry and i want out of here. come here, now!! so i think the yawns were probably practice vocals!!. oh by the way, kyle was the perfect baby. 🙂

  2. I love hearing about the babies 🙂 But how is mama? Are you still experiencing back pain? Pelvic pain? Are you glad to be resting finally? Does that help with your pain or make it worse??? I can’t wait to see pictures of the two beautiful girls on here 🙂 I’m praying for you, and am so glad that you are doing so well thus far. You’re a trooper!!

    By the way…. Did you know Kraig and I are moving down to cincinnati in the fall?? I think a visit to see you four should be in order. And my sister is in her last year at Miami, preggers, and working as a unit secretary at fairfield hospital (i think) so if you or your hubbs are ever there you should look her up and give her some encouragement. She’s about 16 weeks now.

  3. Shelly – no update on the weight, since we still have a growth check scheduled for Tuesday. We’ll get weights then, and hopefully Baby A will move a bit to prove the BPP wrong. Otherwise, we’ll probably head on over to L&D for more monitoring. We’ll keep you posted!

    J — Thanks for checking in! I’m excited that you guys are moving down to Cincinnati! Do you know where yet? What are Sam’s plans after graduation? As for me, the resting mostly makes me feel like crap, and battle boredom and depression. We’re so ready to meet these girls! I can’t wait to see you when you guys are down!

  4. We are not sure exactly where yet, though we are looking in hyde park and mt washington. By “looking” i of course mean that I spend way too much time apartment shopping online! I hope those cicadas are all gone by the time we come visit though, i remember their last invasion and it was not so pretty.
    Sam’s plans after graduation (in 2009) change a lot. I’m sure they’ll continue to change once baby comes. She eventually wants to be a midwife.
    I hope the girls come soon so you aren’t so bored (among other reasons, of course!)

    -Jacquelyn

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