Abnormal Nonstress Test yet Otherwise Reassuring Biophysical Profile in a Compromised Fetus with Severe Antepartum Intracranial Hemorrhage

Abstract

The fetal biophysical profile (BPP), a widely accepted modality of assessment of fetal well-being, significantly shortens the time required to document reassuring fetal testing and exhibits lower false-positive and false-negative rates than conventional nonstress testing. We describe a case in which a patient presenting for fetal testing due to suspected fetal growth restriction at 29 weeks of gestation with recent onset of decreased fetal movements exhibited a concerning nonreactive nonstress test. BPP assessment revealed active fetal tone, movements, breathing movements and amniotic fluid volume (BPP score 8/8). Despite the reassuring BPP, continued abnormal nonstress 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 infarction. This case exhibits limitations of the BPP.