What is the expected management for a biophysical profile (BPP) score of 4 or less?

A biophysical profile (BPP) score of 4 or less indicates a significant risk for fetal compromise. The BPP assesses five components: fetal heart rate reactivity, fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume. Each component is scored on a scale from 0 to 2, and a low overall score, particularly 4 or less, suggests that the fetus may be experiencing distress or inadequate oxygenation.

In such cases, immediate delivery is often warranted, especially if the gestational age is sufficient and there are any concerning clinical findings (e.g., reduced fetal movement, oligohydramnios, or abnormal fetal heart rate patterns). This action is taken to minimize the risk of stillbirth or further complications. Thus, the correct management for a BPP score of 4 or less is delivery, as continuing with expectant management or repeating the test would not adequately address the potential jeopardy to fetal well-being.