BIOPHYSICAL PROFILE TESTING AS AN INDICATOR OF FETAL WELL-BEING IN HIGH-ORDER MULTIPLE GESTATIONS

OBJECTIVE: The purpose of this investigation was to determine the valu e of biophysical profile testing in preventing intrapartum death in pa tients with high-order multiple gestations (triplets or quadruplets). STUDY DESIGN: A retrospective review was performed of patients with tr iplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primary method of fetal surveillance in these pregnancies. Fetal heart rate monitoring on an external monitor was used as back-up and i n cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nons tress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8/8 was therefore co nsidered reassuring, 4/8 equivocal, and 0 or 2/8 possibly abnormal. Te sting was done twice per week. RESULTS: Eighteen patients with triplet s and six patients with quadruplets constituted the study group. The l ast biophysical profile before delivery was examined to evaluate the v alue of the test. There were no antepartum deaths in these 78 babies. The last biophysical profile score was 2/8 in nine fetuses of five tri plet pregnancies and two fetuses of one quadruplet pregnancy. These si x pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortali ty in the 19 babies delivered because of abnormal biophysical profile testing. Four pregnancies had poor outcome at delivery in spite of 8/8 biophysical profile scores on all babies within 4 days of delivery. O f these four, two patients had worsening pregnancy-induced hypertensio n, one had abruptio placentae, and one had a severely growth-retarded infant. CONCLUSION: There were no stillbirths in this series. Twenty-f ive percent of these pregnancies eventually were delivered for nonreas suring biophysical profile testing, with good outcome. Four pregnancie s had poor neonatal outcome in spite of normal biophysical profile tes ting. All of these pregnancies had active changes in physiologic featu res leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labo r). The biophysical profile appears to be a reliable antepartum test o f fetal well-being in triplets and quadruplets.