title: A comparison of Doppler and biophysical findings between liveborn and stillborn growth-restricted fetuses.
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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Sarah
authors.initials: S
authors.lastname: Crimmins
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Andrea
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Dana
authors.initials: D
authors.lastname: Block-Abraham
authors.affiliation: Department of Obstetrics and Prenatal Medicine, Friedrich-Wilhelm University, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berg
authors.affiliation: Department of Obstetrics and Prenatal Medicine, Friedrich-Wilhelm University, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD. Electronic address: abascha1@jhmi.edu.
authors.forename: Ahmet Alexander
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D015148:Cardiotocography; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D050498:Live Birth; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*; D014471:Umbilical Veins / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Doppler; biophysical profile; fetal growth restriction; stillbirth