When doctors become concerned about the health of an unborn child, they often perform testing to determine the baby’s status in the womb. Two of the most common tests are the non-stress test and the biophysical profile. One or both can be done for various reasons, but what’s the difference?
A non-stress test (NST) is usually done in the 3rd trimester before a woman enters labor. It uses a fetal heart rate monitor to assess the baby’s resting heart rate and any changes in the baby’s heart rate as it moves around in the uterus. It also monitors the presence or absence of uterine contractions and their effect on the fetal heart rate. In this test, the mother may be given a button to press when she feels the baby move, which can help determine if heart rate accelerations are tied to movements.
A healthy fetus that is receiving adequate blood flow from its mother will spontaneously have multiple temporary accelerations in its heart rate during the testing period (termed a “reactive” or “reassuring” NST), and a fetus that’s under stress will have few accelerations (a “non-reactive” or “non-reassuring” NST). When a non-stress test is non-reactive, it’s a warning that something may be wrong and further testing is needed.
A biophysical profile (BPP) is a prenatal evaluation that can be performed after the 28th week of pregnancy. It helps to evaluate the health of an unborn child by using an ultrasound to measure fetal body movements, muscle tone, breathing movement, heart rate, and amniotic fluid level. This test is usually performed after a non-stress test has been shown to be non-reactive but may also be done for other reasons. The BPP assigns points to each assessed area, which can add up to a number ranging from 0 to 10.
These tests are relatively commonplace but aren’t done with every pregnancy. Instead, they’re typically reserved for when a healthcare provider wants to check on the health of a fetus, such as if the due date has passed, if a pregnancy is considered high-risk, or if the mom is reporting a decrease in fetal movements.
Typically the non-stress test is the first step when a fetus’s health is in question because it requires less expertise to administer and evaluate. If the test is non-reactive, it can mean there’s a problem with the pregnancy, and further investigation is required to determine if medical intervention is warranted. A test will also be labeled non-reactive if the baby is sleeping during the test, so further testing is essential before making important decisions about whether or not to intervene. A biophysical profile is typically the next step when there’s any doubt after an NST.
When a biophysical profile is done, any score below a 6 is typically cause for concern. Lower scores indicate that the baby might not be getting enough oxygen, and labor may need to be induced. When the BPP score is very low, the baby may even need to be delivered by C-section if it’s determined that attempting a vaginal birth would be too stressful.
When a pregnant woman complains that she’s feeling fewer fetal movements, an NST is commonly done. However, if a provider ignores her complaints and fails to order further testing, they could be held liable for any harm to her child due to that failure to test. Likewise, if an NST is performed and is non-reactive, but a provider ignores or dismisses the results and fails to order a BPP, that provider could be considered negligent for causing harm.
When a doctor is concerned for an unborn baby’s health and orders either an NST or BPP, they’re also expected NOT to provide medical intervention unless it’s actually deemed medically necessary. So, for example, if a pregnant woman has a reactive NST and a BPP with a score of 9 and her provider recommends an early delivery via C-section, then that provider could be held negligent for any harm to the mother or child that occurs (unless there’s some other underlying health condition that would make an early delivery medically necessary).
When the worst happens, and the pregnancy ends in a catastrophic injury or wrongful death, the legal team at Ross Feller Casey is here to help get the justice you and your family deserve. Our experienced lawyers and Ivy League-trained doctors will review the details of your case and determine whether another competent healthcare professional would have provided different care that could have spared you or your child from harm.
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