Abnormal nonstress test yet otherwise reassuring biophysical profile in a compromised fetus with severe antepartum intracranial hemorrhage

The fetal biophysical profile (BPP), a widely accepted modality of assessme nt of fetal well-being, significantly shortens the time required to documen t reassuring fetal testing and exhibits lower false-positive and false-nega tive rates than conventional nonstress testing. We describe a case in which a patient presenting for fetal testing due to suspected fetal growth restr iction at 29 weeks of gestation with recent onset of decreased fetal moveme nts exhibited a concerning nonreactive nonstress test. BPP assessment revea led active fetal tone, movements, breathing movements and amniotic fluid vo lume (BPP score 8/8). Despite the reassuring BPP, continued abnormal nonstr ess 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 infarc tion. This case exhibits limitations of the BPP. Copyright (C) 2001 S. Karg er AG, Basel.