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Table 10 Impact of fetal BPP scoring on stillbirth and perinatal outcomes

From: Reducing stillbirths: screening and monitoring during pregnancy and labour


Location and Type of Study


Stillbirths/Perinatal Outcomes

Reviews and meta-analyses

Lalor et al. 2008 [1]


Meta-analysis (Cochrane). 4 RCTs included (N = 2839 pregnant women).

Compared the effects of complex (BPP; intervention) vs. simple fetal monitoring (cardiotocography and maximum pool depth) (controls).

PMR (including major malformations): RR = 1.33 (95% CI: 0.60–2.98) [NS]

[13/1405 vs. 10/1434 in intervention vs. control groups, respectively].

PMR: RR = 1.30 (95% CI: 0.58–2.92) [NS]

[13/1405 vs. 11/1434 in intervention vs. control groups, respectively].

Observational studies

Awad 1991 [101]

Egypt. Al Fayrouz Hospital.

Before-after study. N = 319 women (N = 160 intervention, N = 159 controls). Routine BPP introduced in 1990; compared to historical controls without BPP at same hospital prior to 1990.

Assessed the impact on perinatal mortality of introduction of routine BPP (intervention) vs. historical controls.

SBR: 0/1000 vs. 6/29/1000 in intervention vs. control groups, respectively.

PMR (excluding malformations and alloimmunization disorders): 6.25/1000 vs. 25.16/1000 in intervention vs. control groups, respectively.

Golde et al. 1984 [97]

USA. University of Southern California Medical Centre and Women's Hospital, Los Angeles,

Case series. Pregnant diabetic women (N = 107) vs. historic controls (N = 140) undergoing antepartum fetal surveillance.

Compared the impact of a package of nonstress heart rate testing, backed up by either fetal BPP or CST twice weekly (intervention), vs. weekly NSTs and daily plasma estriols (controls).

SB: 3/107 vs. 1/140 in intervention vs. control groups, respectively. 0 unexplained losses in either group.

de la Vega A 2002 [95]

Puerto Rico. Private clinic.

Case series. Pregnancies (N = 1810) ≥20 wks gestation. High-resolution sonograph was performed in each trimester; BPP in 3rd trimester if risk factor was identified.

To assess the impact of testing fetal well-being using sonography and BPP in clinic cases (intervention) compared with the US average.

SBR: 14/1810 (7.7/1000 births) in this series vs. the U.S. national average of 6.7–7.8/1000 births.

Kennelly et al. 2007 [96]

UK. Single tertiary centre.

Retrospective study. Records from Fetal Medicine Database, 2000–2005. Pregnant women (N = 39) with SGA twins (19 monochorionic sets, 13 dichorionic sets) with absent or reversed end diastolic flow in the umbilical artery.

To assess the impact of active monitoring with daily BPP after estimated fetal weight ≥500 g in both twins and gestational age ≥24 wks. Delivery was timed based on abnormal BPP, two equivocal BPP within 12 h or gestational age ≥32 wks.

Fetal death (miscarriage+SB): None.