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INTRAUTERINE GROWTH RESTRICTION |
Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1231-6.
Fetal death after normal biophysical profile score: An eighteen-year
experience.
Dayal AK, Manning FA, Berck DJ, Mussalli GM, Avila C, Harman CR, Menticoglou
S.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology,
Columbia-Presbyterian Medical Center, New York, New York, USA.
Objectives:
It was our goal to determine the false-negative rate of the
biophysical profile, characterize an 18-year variation in the false-negative
rate, examine the relationship between the last normal biophysical profile
score and death, and compare the false-negative rate of 2 disparate
populations.
Study Design:
Biophysical profile scores of 86,955 patients at
2 medical centers were collected and recorded prospectively. All perinatal
deaths occurring within 1 week of a normal score were similarly recorded.
The annual false-negative rate, the cumulative false-negative rate, and the
ratio of false-negative results in cases of subsequent fetal death to the
perinatal mortality rate were calculated.
Results:
There were 65 fetal
deaths among 86,955 fetuses. Over an 18-year study period at one
institution, the false-negative rate varied but not significantly. The
cumulative false-negative rate was 0.708 per 1000 at one medical center
studied and 2.289 per 1000 at the other center. The average interval between
last normal score and fetal death was 3.62 days and did not vary
significantly between the medical centers.
Conclusions:
False-negative
results in cases of subsequent fetal death reflect events that are
subsequent to the last normal test result. Fetomaternal hemorrhage was the
single most identifiable fetal cause of false-negative results in cases of
subsequent fetal death. The ratio of the false-negative rate in cases of
subsequent fetal death to the perinatal mortality rate should be used as a
more objective approach to reporting this value, because the false-negative
rate likely reflects the underlying perinatal mortality.
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