Re: BPP 2 and reassuring tracing
From: art fougner, md (evsono@pipeline.com)
Wed Apr 22 16:42:26 2009
Readily admitting that one anecdote does not evidence make, we are all,
nevertheless, products of our experience. So my anecdote involved a
woman referred for decreased fetal movement for one day at 37 wks ...
the ultrasound revealed normal af volume, some movement, hand during the
study opened and closed and there was one episode of sustained fetal
breathing movements. The NST, however, appeared sinusoidal and
persisted that way for an hour. Vibroacoutic stimulation resulted in a
slow rise in heart rate followed by a slow return back to a persistently
sinusoidal pattern.
Patient went to L&D and sinusoidal pattern persisted. She was delivered
by section ( I apologize for forgetting the Apgars) and the Baby was
found profoundly anemic and was transfused promptly, ultimately doing
well.
So had I not done the NST, the outcome might have been considerably less
satisfactory. Therefore, for me, no NST = No Biophysical profile.
Just my opinion. I could be wrong.
Art
At Wed, 22 Apr 2009, R. Daniel Braun wrote:
>
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>Manning & Platt's BPP included an NST done without EFM. If the
>ultrasonographer could see a visible increase in the heart rate with fetal
>movement, the NST was reactive.
>As with all tests, if the test is not done correctly, the results are
>worthless. The vast majority of abnormal BPP's, that were referred to me
>were really quite normal by the time I saw the patient. Upon looking into
>these cases, the usual cause was that the person did not observe for the
>full 30 minutes required to say that there was no fetal breathing or fetal
>movement or fetal tone.
>
>Dan
>
>On Wed, Apr 22, 2009 at 3:05 PM, art fougner, md <evsono@pipeline.com>wrote:
>
>> IMHO ... Manning and Platt's biophysical profile included an NST. I
>> personally would not accept a Biophysical profile without an NST.
>>
>> Art
>>
>> At Wed, 22 Apr 2009, Andrew Folley wrote:
>> >
>> >Same patient as John described. Primip at term in latent phase of labor..
>> BPP is 2 out of 8 in the office. ie no tone, movement and no respirations
>> but a 2 for AFI of 7. This is hypothetical situation.
>> >
>> >Date: Wed, 22 Apr 2009 12:10:29 -0500
>> >From: DoctorJoe@aol.com
>> >To: ob-gyn-l@mail.obgyn.net
>> >Subject: Re: BPP 2 and reassuring tracing
>> >
>> >In a message dated 4/22/09 11:59:18 AM, agfolley@hotmail.com writes:
>> >
>> >Let me turn the tables and pose this question: Same patient of Johns sent
>> over from office
>> >with decreased fetal movement and BPP of 2. Does she get
>> immediatec-section? What if she is put on monitor awaiting the c-section
>> and the tracing is "reactive" ie category I?
>> >what do you do??
>> >
>> >Doesn't a reactive strip give her a higher BPP? And is this reactive in
>> the face of some contractions or not?
>> >
>> >I'd still be awfully worried about the decreased fluid and decreased
>> (perception of) fetal movement.
>> >
>> >However, you've left off an important datum: gestational age.
>> >
>> >Joe P.
>> >
>> >adio Toolbar! (
>> http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003)
>>
>> --
>> art fougner, md
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>
>--
>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>--
>R. Daniel Braun
>
> “Science without Religion is LAME; Religion without Science is BLIND"
> Einstein 1941
>
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>Manning & Platt's BPP included an NST done without EFM. If the ultrasonographer could see a visible increase in the heart rate with fetal movement, the NST was reactive.<br>As with all tests, if the test is not done correctly, the results are worthless. The vast majority of abnormal BPP's, that were referred to me were really quite normal by the time I saw the patient. Upon looking into these cases, the usual cause was that the person did not observe for the full 30 minutes required to say that there was no fetal breathing or fetal movement or fetal tone.<br>
><br>Dan<br><br><br><br><br><br><div class="gmail_quote">On Wed, Apr 22, 2009 at 3:05 PM, art fougner, md <span dir="ltr"><<a href="mailto:evsono@pipeline.com">evsono@pipeline.com</a>></span> wrote:<br><blockquote class="gmail_quote" style="border-left: 1px solid rgb(204, 204, 204); margin: 0pt 0pt 0pt 0.8ex; padding-left: 1ex;">
>IMHO ... Manning and Platt's biophysical profile included an NST. I<br>
>personally would not accept a Biophysical profile without an NST.<br>
><font color="#888888"><br>
>Art<br>
></font><div class="im"><br>
>At Wed, 22 Apr 2009, Andrew Folley wrote:<br>
>><br>
></div><div class="im">>Same patient as John described. Primip at term in latent phase of labor. BPP is 2 out of 8 in the office. ie no tone, movement and no respirations but a 2 for AFI of 7. This is hypothetical situation.<br>
>
>><br>
>>Date: Wed, 22 Apr 2009 12:10:29 -0500<br>
>>From: <a href="mailto:DoctorJoe@aol.com">DoctorJoe@aol.com</a><br>
></div><div class="im">>To: <a href="mailto:ob-gyn-l@mail.obgyn.net">ob-gyn-l@mail.obgyn.net</a><br>
></div><div class="im">>Subject: Re: BPP 2 and reassuring tracing<br>
>><br>
>>In a message dated 4/22/09 11:59:18 AM, <a href="mailto:agfolley@hotmail.com">agfolley@hotmail.com</a> writes:<br>
>><br>
></div><div class="im">>Let me turn the tables and pose this question: Same patient of Johns sent over from office<br>
>>with decreased fetal movement and BPP of 2. Does she get immediatec-section? What if she is put on monitor awaiting the c-section and the tracing is "reactive" ie category I?<br>
>>what do you do??<br>
>><br>
></div><div class="im">>Doesn't a reactive strip give her a higher BPP? And is this reactive in the face of some contractions or not?<br>
>><br>
>>I'd still be awfully worried about the decreased fluid and decreased (perception of) fetal movement.<br>
>><br>
>>However, you've left off an important datum: gestational age.<br>
>><br>
>>Joe P.<br>
>><br>
></div><div class="im">>adio Toolbar! (<a href="http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003" target="_blank">http://toolbar.aol.com/aolradio/download.html?ncid=emlcntusdown00000003</a>)<br>
></div><div><div></div><div class="h5">--<br>
>art fougner, md<br>
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton<br>
></div></div></blockquote></div><br>
>
>raun, MD FACOG(L) ABMP CMTh<br>Professor Emeritus<br>Dept. of Obstetrics and Gynecology<br>Indiana U. School of Medicine<br><br><br>R. Daniel Braun<br>
><br> “Science without Religion is LAME; Religion without Science is BLIND"<br> Einstein 1941<br>
>
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>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
