Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations

The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets).

A retrospective review was performed of patients with triplets 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 in cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nonstress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8/8 was therefore considered reassuring, 4/8 equivocal, and 0 or 2/8 possibly abnormal. Testing was done twice per week.

Eighteen patients with triplets and six patients with quadruplets constituted the study group. The last biophysical profile before delivery was examined to evaluate the value 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 triplet pregnancies and two fetuses of one quadruplet pregnancy. These six pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortality 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. Of these four, two patients had worsening pregnancy-induced hypertension, one had abruptio placentae, and one had a severely growth-retarded infant.

There were no stillbirths in this series. Twenty-five percent of these pregnancies eventually were delivered for nonreassuring biophysical profile testing, with good outcome. Four pregnancies had poor neonatal outcome in spite of normal biophysical profile testing. All of these pregnancies had active changes in physiologic features leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labor). The biophysical profile appears to be a reliable antepartum test of fetal well-being in triplets and quadruplets.