Biophysical profile scoring in the management of the diabetic pregnancy.

Abstract

Biophysical profile scoring was the principal technique of antepartum fetal surveillance in 238 well-controlled diabetic pregnancies. Fifty insulin-dependent diabetics had twice-weekly testing, and 188 gestational diabetics had weekly testing. Intervention was not pursued unless there were maternal or fetal complications. There were no stillbirths and three neonatal deaths, all resulting from congenital anomalies, giving a corrected perinatal mortality rate of 0. The incidence of abnormal biophysical profile scores, eight of 238 (3.3%) overall, was low, with no significant difference between types of diabetics. In those with an abnormal score, intervention was mandated; the cesarean section rate was 50% and the rate of intensive care nursery admissions was high. Of the 230 fetuses with a normal biophysical profile score, 200 (87%) were delivered at term with minimal maternal or neonatal morbidity. Amniocentesis for phospholipid profile was performed in only 33 cases (13.9%). Hyaline membrane disease was confined to five premature neonates (incidence 2.1%). We conclude that antepartum fetal surveillance using the biophysical profile score permits safe expectant management in the diabetic pregnancy, yielding significant clinical advantages to both mother and fetus.