title: Abnormal nonstress test yet otherwise reassuring biophysical profile in a compromised fetus with severe antepartum intracranial hemorrhage.
abstract: The fetal biophysical profile (BPP), a widely accepted modality of assessment of fetal well-being, significantly shortens the time required to document reassuring fetal testing and exhibits lower false-positive and false-negative rates than conventional nonstress testing. We describe a case in which a patient presenting for fetal testing due to suspected fetal growth restriction at 29 weeks of gestation with recent onset of decreased fetal movements exhibited a concerning nonreactive nonstress test. BPP assessment revealed active fetal tone, movements, breathing movements and amniotic fluid volume (BPP score 8/8). Despite the reassuring BPP, continued abnormal nonstress testing led to subsequent abdominal delivery of an acidotic infant with evidence of a massive antepartum intracranial insult consisting of frontal intraparenchymal hemorrhage and a right temporal-occipital cortical infarction. This case exhibits limitations of the BPP.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Sherer
authors.forename: M G
authors.initials: MG
authors.lastname: Kogan
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D001034:Apgar Score; D001921:Brain / Q000503:physiopathology; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011247:Pregnancy; D014463:Ultrasonography