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

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


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Blood Flow Velocity
  • Cardiotocography
  • Cohort Studies
  • Female
  • Fetal Growth Retardation / diagnostic imaging*
  • Fetal Growth Retardation / physiopathology
  • Gestational Age
  • Humans
  • Live Birth*
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging*
  • Pregnancy
  • Retrospective Studies
  • Stillbirth*
  • Ultrasonography, Doppler
  • Ultrasonography, Prenatal
  • Umbilical Arteries / diagnostic imaging*
  • Umbilical Veins / diagnostic imaging*
  • Young Adult