Fetal biophysical profile scoring was used as a method for antepartum fetal risk assessment in 12,620 high-risk patients referred in a 55-month interval. A total of 26,257 tests were performed on these patients (range, one to 18 tests per patient). Ninety-three perinatal deaths occurred (gross perinatal mortality rate, 7.37 per 1000) of which 62 (66.6%) were due to a major anomaly, seven were due to Rh disease (7.5%), and the remaining 24 deaths (25.8%) occurred in structurally normal fetuses. The corrected perinatal mortality rate was 1.90 per 1000. Eight structurally normal fetuses died within 1 week of a normal test result (corrected false negative rate, 0.634 per 1000). These data suggest fetal biophysical profile scoring is an accurate method for identification of the fetus at risk for perinatal death.