title: An assessment of predictive value of the biophysical profile in women with preeclampsia using data from the fullPIERS database.
abstract: BACKGROUND
  Pre-eclampsia is associated with increased risk to both the mother and fetus. Effective monitoring of the fetal condition is essential to the management of women with pre-eclampsia. The biophysical profile (BPP) is one monitoring tool available to clinicians.
  
  
  OBJECTIVE
  To compare the BPP test with cardiotocography/non-stress test (CTG/NST) alone for their ability to predict fetal acidemia at birth or a composite adverse perinatal outcome among women with preeclampsia and to estimate the effect of BPP assessment on mode of delivery and birth outcome.
  
  
  METHODS
  Secondary analysis of a prospective cohort of women with preeclampsia. The predictive ability of the tests was assessed based on sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-). Women assessed with the BPP were compared with matched controls not assessed with the BPP to determine the odds of Cesarean delivery or adverse perinatal outcomes after adjustment for potential confounders.
  
  
  RESULTS
  Five out of 89 women (5.6%) had an abnormal BPP; 18 out of 89 (20.2%) had an abnormal CTG/NST. Fetal acidemia was diagnosed in 13 fetuses (14.6%); composite adverse perinatal outcome in 68 fetuses/infants (76.4%). Both tests had relatively poor predictive performance for both outcomes (LR+ between 2.50 and 3.90 and LR- between 0.64 and 0.93). Assessment with the BPP was positively associated with fetal acidemia (adjusted OR 4.84; 95% CI 1.33-17.66).
  
  
  CONCLUSIONS
  The BPP and CTG/NST alone were poor predictors of perinatal outcome in this cohort; multiple tests should be considered when assessing fetal risk in women with preeclampsia.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, BC, Canada; Child & Family Research Institute, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand. Electronic address: bayne@cw.bc.ca.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Payne
authors.affiliation: Department of Medicine, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Phillipa M
authors.initials: PM
authors.lastname: Kyle
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, BC, Canada; Child & Family Research Institute, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Sarka
authors.initials: S
authors.lastname: Lisonkova
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, BC, Canada; Department of Medicine, University of British Columbia, BC, Canada; Child & Family Research Institute, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Barbra
authors.initials: B
authors.lastname: Pullar
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Ziguang
authors.initials: Z
authors.lastname: Qu
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, BC, Canada; Child & Family Research Institute, University of British Columbia, BC, Canada; Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
keywords: Biophysical profile; Fetal assessment; Preeclampsia