Petrović O, Skunca E, Matejcić N
Department of Obstetrics and Gynecology, University of Rijeka, Croatia.
Int J Gynaecol Obstet. 1998 Apr;61(1):9-14. doi: 10.1016/s0020-7292(98)00009-5.
To modify the classic fetal biophysical profile (FBP) with the aim of obtaining rapid and accurate information about actual fetal condition in non-compromised fetuses with a subsequent favorable outcome and to be suitable for a number of outclinic patients.
Four-hundred and ninety-four fetuses from singleton pregnancies in two randomized groups were monitored by the modified FBP (mFBP) and 168 of them after the external vibratory acoustic stimulation (VAS/mFBP). The mFBP was characterized by two main characteristics: non-stress test was excluded and the testing was finished at the moment when all of the three fetal biophysical activities became normal. The external VAS was applied only in cases with no evidence of fetal activity at the start of the FBP.
Of the examined fetuses, 326 fetuses in the control group were monitored by the mFBP and there were 316 (96.9%) favorable outcomes and 10 (3.1%) adverse perinatal outcomes. The sensitivity, specificity and positive and negative predictive values of the mFBP score in predicting adverse perinatal outcome were 60, 99, 66.7 and 98.7%, respectively. In the study group of 168 fetuses there were 165 (98.2%) favorable outcomes and three (1.8%) adverse perinatal outcomes. The sensitivity, specificity and positive and negative predictive values of the VAS/mFBP were 66.7, 100, 100 and 99.4%, respectively. The efficiency of the VAS/mFBP in predicting perinatal mortality alone was even higher. After the external VAS and the first 5 min of the modified testing approximately two-fifths (41.8%) of healthy fetuses with a subsequent good outcome exhibited normal in all of the three biophysical activities and approximately two-thirds (65.5%) of them after 10 min. In the VAS/mFBP group of healthy fetuses, during the same time periods, normal breathing movements were observed in 72% and 87% of fetuses, respectively.
According to our results the mFBP and particularly the VAS/mFBP antenatal protocol as a new and rational variant of the FBP could improve fetal assessment allowing in cases of non-compromised fetuses rapid and accurate information about actual fetal well-being. Because of its high accuracy and a reduced testing time the antepartal method with observation of fetal breathing movements after VAS is becoming acceptable as a screening of fetal well-being evaluation in outclinic conditions.
对经典胎儿生物物理评分（FBP）进行改良，旨在快速、准确地获取非高危胎儿实际状况的信息，以期获得良好结局，并适用于大量门诊患者。
将494名单胎妊娠胎儿随机分为两组，分别采用改良FBP（mFBP）进行监测，其中168例在进行外部振动声刺激后采用改良FBP（VAS/mFBP）监测。mFBP有两个主要特点：排除无应激试验，且当三项胎儿生物物理活动均恢复正常时即完成检查。仅在FBP开始时无胎儿活动迹象的情况下才进行外部VAS刺激。
在接受检查的胎儿中，对照组326例胎儿采用mFBP监测，围产期结局良好的有316例（96.9%），不良围产期结局10例（3.1%）。mFBP评分预测不良围产期结局的敏感性、特异性、阳性预测值和阴性预测值分别为60%、99%、66.7%和98.7%。在168例胎儿的研究组中，围产期结局良好的有165例（98.2%），不良围产期结局3例（1.8%）。VAS/mFBP的敏感性、特异性、阳性预测值和阴性预测值分别为66.7%、100%、100%和99.4%。VAS/mFBP单独预测围产儿死亡率的效率更高。在进行外部VAS刺激及改良检查的前5分钟后，约五分之二（41.8%）随后结局良好的健康胎儿三项生物物理活动均恢复正常，10分钟后约三分之二（65.5%）恢复正常。在VAS/mFBP组的健康胎儿中，在相同时间段内，分别有72%和87%的胎儿观察到正常呼吸运动。
根据我们的研究结果，mFBP尤其是VAS/mFBP产前方案作为FBP的一种新的合理变体，可以改善胎儿评估，在非高危胎儿情况下能够快速、准确地获取胎儿实际健康状况的信息。由于其高准确性和缩短的检查时间，VAS后观察胎儿呼吸运动的产前方法正逐渐被接受，可作为门诊条件下胎儿健康评估的筛查方法。
