A comparison of Doppler and biophysical findings between liveborn and stillborn growth-restricted fetuses

Sarah Crimmins, Andrea Desai, Dana Block-Abraham, Christoph Berg, Ulrich Gembruch, Ahmet Alexander Baschat

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: The purpose of this study was to evaluate the surveillance characteristics that precede stillbirth in growth-restricted fetuses that receive integrated Doppler and biophysical profile scoring (BPS). STUDY DESIGN: Nine hundred eighty-seven singleton pregnancies that were complicated by fetal growth restriction had multivessel Doppler scans (umbilical and middle cerebral arteries [MCA], ductus venosus, and umbilical vein) and BPS. Surveillance findings were compared between live births and stillbirths. RESULTS: Forty-seven stillbirths occurred in 2 clusters, 37 at <34 weeks of gestation and 10 thereafter. Before 34 weeks of gestation, stillbirths had parallel escalation of umbilical artery and ductus venosus Doppler findings followed by abnormal BPS. At ≥34 weeks of gestation, only a decline in MCA pulsatility index was observed, and 75% of stillbirths were unanticipated by the BPS. CONCLUSION: Before 34 weeks of gestation, multivessel Doppler abnormality anticipates an abnormal BPS and subsequent stillbirth. After 34 weeks of gestation, stillbirths occur after MCA brain-sparing in a shorter interval than predicted by a normal BPS. Recognition of these differences in clinical behavior requires consideration for the planning of monitoring intervals in preterm and term fetal growth restriction.

Original languageEnglish (US)
Pages (from-to)669.e1-669.e10
JournalAmerican journal of obstetrics and gynecology
Volume211
Issue number6
DOIs
StatePublished - Dec 1 2014

Keywords

  • Doppler
  • biophysical profile
  • fetal growth restriction
  • stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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