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Am J Obstet Gynecol. 2014 Dec;211(6):669.e1-10. doi: 10.1016/j.ajog.2014.06.022. Epub 2014 Jun 12.

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

Author information

1
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
2
Department of Obstetrics and Prenatal Medicine, Friedrich-Wilhelm University, Bonn, Germany.
3
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD. Electronic address: abascha1@jhmi.edu.

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.

KEYWORDS:

Doppler; biophysical profile; fetal growth restriction; stillbirth

PMID:
24931475
DOI:
10.1016/j.ajog.2014.06.022
[Indexed for MEDLINE]

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