“Efficacy of Biophysical Profile in Antepartum Fetal Surveillance of High‑Risk Pregnancies: A Systematic Review of Clinical Evidence”

Abstract

Introduction: Perinatal morbidity and mortality is associated with high risk pregnancies, such as preeclampsia, oligohydramnios, intrauterine growth restriction and gestational diabetes. Fetal compromise is the most important issue to detect early and to take appropriate clinical action at the right time. The biophysical profile (BPP) and modified biophysical profile (MBPP) are non-invasive techniques that use ultrasound and cardiotocographic (CTG) measurements to evaluate fetal well-being. The comparison of the effectiveness of BPP and MBPP in high-risk pregnancies is being investigated, but it is widely used.

Objective: To systematically review clinical evidence published from 2017 to 2026 about the effectiveness of BPP and MBPP in antepartum fetal surveillance of high-risk pregnancies, and their relationship with perinatal outcomes.

Methodology: A systematic literature search was performed in PubMed, Scopus, Web of Science, Embase and the Cochrane Library for original studies on BPP and MBPP in high-risk pregnancies. Studies that reported perinatal outcomes (fetal distress, Apgar scores, NICU admission, or cesarean delivery) were included. Cohort studies and randomized controlled trials were reviewed. The information sought included characteristics of the study, type of BPP, patient populations, outcomes, and findings. The Newcastle–Ottawa Scale for observational studies and the Cochrane RoB 2 for RCTs were used to assess the risk of bias.

Results: There were 12 studies that were included. Both BPP and MBPP have proven to be effective in identifying fetal compromise. Low APGAR scores, NICU admission, and high cesarean delivery rates were all associated with abnormal MBPP scores, which occurred in every case. The predictive ability of MBPP was similar to full BPP and it also provided a more quick and resource-saving evaluation. Doppler integration added to the predictive capability. The heterogeneity in scoring thresholds, and in the study design, was observed, and most studies were observational and had moderate risk of bias.

Conclusion: BPP and MBPP are useful and effective means of fetal monitoring in high risk pregnancies. MBPP offers a clinically useful and time-saving approach, without sacrificing predictive accuracy, that would be useful in situations where a rapid assessment is needed.