<prompt> Modified BPP consists of:NST with AFINST with fetal breathingNST with fetal movementNST with fetal tone  <response>: Ans. a. NST with amniotic fluid index Ref: Williams Obstetrics 24e p342. 343Modified Biophysical profile consists of NST with amniotic fluid index.Modified Biophysical Profile: Because the biophysical profile is labor intensive and requires a person trained in sonography, Clark and coworkers 1989 used an abbreviated biophysical profile as a first-line screening test in 2628 singleton pregnancies. Specifically, a vibroacoustic nonstress test was performed twice weekly and combined with amnionic fluid index determination for which 5 cm was considered abnormal. This abbreviated biophysical profile required approximately 10 minutes to perform, and they concluded that it was a superb antepartum surveillance method because there were no unexpected fetal deaths. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics 2012 have concluded that the modified biophysical profile test is as predictive of fetal well-being as other approaches to biophysical fetal surveillance. -- Williams Obstetrics 24e 343Biophysical ProfileManning proposed combined use of 5 fetal biophysical variables as a more accurate means of assessing fetal health than a single elementQ.Typically, these tests require 30 to 60 minutes of examiner tuneQ.5 fetal biophysical components assessed: 1 heart rate acceleration, 2 breathing, 3 movements, 4 tone, and 5 amniotic fluid volumeQ.Normal variables were assigned a score of 2 each, and abnormal variables were given a score of 0Q.Highest score possible for a normal fetus is 10Q.Components and Scores for the Biophysical ProfileComponentScore 2Score 0Non stresstest 2 acceleration of 15 beatsmin for 15 sec within 20-40 min0 or 1 acceleration within 20- 40 minutesFetal breathing 1 episode of rhythmic breathing lasting 30 sec within 30 min 30 sec of breathing within 30Fetal movement 3 discrete body or limb movements within 30 min 3 discrete movementsFetal tone 1 episode of extremity extension and subsequent return to flexion0 exiensionflextion eventsAmniotic fluid volumeA pocket of amniotic fluid that measure at least 2 cm in two planes perpendicular to each other 2 x 2 cm pocketLargest single vertical pocket 2 Interpretation of Biophysical Profile ScoreBiophysical profile ScoreInterpretationRecommended Management10Normal, non-asphyxiated fetus No fetal indication for intervention, repeat test weekly except in diabetic patients Post-term pregnancy twice weekly810 Normal AFV 88 NST not doneNormal, non-asphyxiated fetus No fetal indication for intervention; repeat testing as per protocol810 Decreased AFVChronic fetal asphyxiasuspected Deliver6Possible fetal asphyxia If amniotic fluid volume abnormal, deliver If normal fluid at 36 weeks with favourable Cervix, deliver If repeat test 6, deliver If repeat test 6, observe, and repeat as per protocol4Probable fetal asphyxia Repeat testing same day; if biophysical profile score 6, deliver0 to 2Almost certain fetal asphyxia Deliver 