In a non-reactive NST (no accelerations in 40 minutes), the next appropriate step is to perform a biophysical profile (BPP). A BPP score of 6/10 (with amniotic fluid index of 5 cm, absent fetal tone, 1 fetal movement, 1 breathing episode, and a non-reactive NST) at 35 weeks indicates:
- A Normal fetal status — repeat BPP in 4 hours
- B Equivocal — repeat BPP in 24 hours
- C Equivocal — consideration of delivery based on clinical context ✓
- D Delivery is not indicated — close outpatient monitoring only
Correct answer: C. Equivocal — consideration of delivery based on clinical context
Explanation
BPP scoring interpretation: 8–10/10 = normal (low risk of asphyxia within 1 week); 6/10 = equivocal — risk of perinatal asphyxia. At term (≥ 36 weeks), a BPP of 6/10 warrants delivery. Before 36 weeks, management is individualised: repeat BPP in 4–6 hours; if still 6/10 or deteriorates, delivery is considered. At 35 weeks, a BPP of 6/10 with oligohydramnios (AFI 5 cm, borderline) and absent fetal tone warrants clinical decision-making about delivery, typically requiring consultation with a perinatologist.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.