“Therapeutic” Bed Rest in Pregnancy
Anne Lyerly2013, Obstetrics & Gynecology
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Abstract
Therapeutic" bed rest continues to be used widely, despite evidence of no benefit and known harms. In this commentary, we summarize the Cochrane reviews of bed rest and propose an ethical argument for discontinuing this practice. Cochrane systematic reviews do not support "therapeutic" bed rest for threatened abortion, hypertension, preeclampsia, preterm birth, multiple gestations, or impaired fetal growth. This assessment has been echoed in other comprehensive reviews. Prescribing bed rest is inconsistent with the ethical principles of autonomy, beneficence, and justice. Hence, if bed rest is to be used, it should be only within a formal clinical trial.
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Therapeutic" bed rest in pregnancy: Unethical and Unsupported by Data
2013
Therapeutic" bed rest continues to be used widely, despite evidence of no benefit and known harms. In this commentary, we summarize the Cochrane reviews of bed rest and propose an ethical argument for discontinuing this practice. Cochrane systematic reviews do not support "therapeutic" bed rest for threatened abortion, hypertension, preeclampsia, preterm birth, multiple gestations, or impaired fetal growth. This assessment has been echoed in other comprehensive reviews. Prescribing bed rest is inconsistent with the ethical principles of autonomy, beneficence, and justice. Hence, if bed rest is to be used, it should be only within a formal clinical trial.
Bed Rest in Pregnancy and Its Related Complications: Is It Needed?
Journal of SAFOG with DVD, 2012
For centuries it is common myth to advice bed rest during pregnancy. At the least pretext bed rest is advised by family members and by health care providers also. But review of literature and RCT shows that in reality bed rest does not alter the course of pregnancy in various complications. Role of bed rest has been examined in singleton, twin and triplet pregnancies but was not found useful. Prolonged bed rest is rather harmful as it causes increased calcium excretion, loss of muscle mass, financial loss and increased psychological rest for the pregnant woman and her family. Moderate exercise is advisable throughout pregnancy to maintain tone of muscles and range of movements. So till we have more proof we should be cautious in advising pregnant patients about bed rest. It can be limited activity where we feel it is not advisable to overexert her. How to cite this article Ahuja M. Bed Rest in Pregnancy and Its Related Complications: Is It Needed?. J South Asian Feder Obst Gynae 201...
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Bedrest has long been recommended for high-risk pregnancies, but recent studies question its effectiveness in improving pregnancy outcomes. To be effective, the women for whom bedrest is recommended must practice it. This study examined degree of compliance and reason for noncompliance in women for whom bedrest was recommended, and outcomes of pregnancy among high-risk women who complied compared with those who did not. The subjects were 326 high-risk pregnant women who were prescribed bedrest for preterm labor, blood pressure problems, or bleeding problems. Of that group, one-third did not comply with the bedrest recommendation. These women had more children, were not currently married, had more stress, did not attend prenatal classes, continued drinking alcohol during pregnancy, and were not trying to get pregnant compared with women who complied. Reasons for noncompliance included the need to care for children, not feeling sick, household demands, lack of partner or family support, need to work, and discomfort. The pregnancy outcomes for the women who complied were similar to those of the women who did not comply. These findings support the importance of more research on the practice of prescribing bedrest to improve pregnancy outcomes.
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2021
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The effect of bed rest after intrauterine insemination on pregnancy outcome
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Doing this PhD thesis would not have been possible without the encouragement and faith of colleagues, friends, and family. Especially, I thank Bodil Møller for pulling the strings making this PhD scholarship possible, Jette Aaroe Clausen for valuable comments, colleagues in Copenhagen and Aarhus for support even though I was periodically absent, and statistician Ole Olsen for accommodating my ideas. I am grateful to my supervisor Rikke Maimburg for the continuous support through dozens of text drafts and for encouraging me to keep on searching for best evidence -even though it sometimes may have been uncomfortable and controversial. May this PhD be just the beginning of a continuous collaboration to promote ethical and evidence-based care. I'd also like to express my gratitude to Mette Juhl, my co-supervisor, for answering epidemiological questions and for being enthusiastic about our work and for the many green chair conversations. Meeting Gene Declercq in Boston for a three-month period was a delightful experience. A special thanks to Gene for sharing expertise about model building as well as discussing topics related to medicalisation in childbirth. I'm grateful to Gene for continued collaboration throughout all three papers and furthermore am thankful for his humorous and amicable ways. Writing a PhD weighs on family relations. My husband Stefan and our children Anton and Alberte allowed me my periods of absent-mindedness and a three-month research stay in Boston. The four-year PhD research period also brought new adventures and friends, and it paved the way for a fantastic road trip across the USA. I'm unconditionally thankful for the PhD grant, financed primary from University College Copenhagen and Aarhus University. Finally, thanks to the Danish Association of Midwives and Herlev Hospital for additional financial grants and to the Hanne Kjaergaard Memorial fund for the scientific award. All indicated an implicit approval of my research topic 'Medicalisation in pregnancy and childbirth' to be relevant to explore and disseminate. The three papers of the thesis ________________________________________________________________________ Paper I (Published) Cesarean section on a rise-Does advanced maternal age explain the increase? A population register-based study.
Induction of labor versus expectant management for post-date pregnancy: Is there sufficient evidence for a change in clinical practice?
Acta Obstetricia et Gynecologica Scandinavica, 2009
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NEEDS DURING BED REST IN HIGH RISK PREGNANCY: A NARRATIVE REVIEW
Background: Pregnancy in women?s life is considered unique and natural period. But when the pregnancy is at high risk, it is recommended to limit activity and treated with bed rest which disturbs natural process of pregnancy. The women develop some needs during the journey of bed rest and want support to get them fulfilled for better maternal and fetal outcome. Objective: To undertake a narrative review so as to explore the needs of high risk pregnant women during bed rest. Method: 8 studies were selected from a period of 1991-2016 after keyword searches for PubMed, EBSCO, DELNET databases and google scholarly articles. Manual searches of other relevant journals and reference list of primary articles were also done. Results: 8 studies were selected for this narrative review including 5 qualitative and 3 quantitative studies. Data analysis of 4 of the studies reported the needs of high risk pregnant women during bed rest like need for consultation due to physical problems, psychological problems, marital problems, fear and stress, need for planning various activities during bed rest, need for counselling on psychological problems, need for social support, need for assistance with emotional adaptation and bed rest. Remaining 4 studies discussed about anxiety, stress, depression and worries faced by women which are factors for arousing specific needs during bed rest in high risk pregnancy. Conclusion: Bed rest interrupts the natural process of pregnancy due to which high risk pregnant mother may sometime feel isolated. During hospitalization, the high risk pregnant mother has high level of stress, anxiety and worries. So, nurse should have a sense of responsibility to assess the needs of high risk pregnant mother and can take help of family members to cope up with the situation.
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Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing, 1997
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The Cochrane library, 2005
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Journal of midwifery and reproductive health, 2018
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BMJ open, 2018
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A Pilot Randomized Controlled Trial Of Complete Bed Rest Versus Activity Restriction After Preterm Premature Rupture of the Membranes
European Journal of Obstetrics & Gynecology and Reproductive Biology
BACKGROUND Preterm premature rupture of the membranes (PPROM) is defined as spontaneous rupture of the membranes before labor at less than 37 weeks of gestation. It complicates 3 percent of pregnancies but is responsible for one third of cases of preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. PPROM etiology is still unclear but underlying infectious process, increased inflammatory pathway activation and genetic predisposition are probably involved. Latency time from PPROM to delivery is usually brief and inversely proportional to gestational age (GA) at rupture. During this time, intrauterine infection, placental abruption, umbilical cord compression or prolapse, and fetal compression and hypoxia are possible consequences. Chorioamnionitis is the major maternal consequence of PPROM. Neonatal morbidity is also higher when PPROM is complicated by chorioamnionitis but prematurity remains the major neonatal consequence after PPROM. Several studies support that prolonged latency improves fetal maturation and does not worsen neonatal prognosis, for a given GA at birth. In order to increase GA at birth, expectant management of viable pregnancies with prophylactic antibiotic administration is recommended. Antepartum bed rest is also widely prescribed, although its effectiveness to prevent preterm birth has not been demonstrated. OBJETIVE We aimed to access the impact of bed rest in latency time to delivery, chorioamnionitis incidence and other maternal and neonatal outcomes in pregnancies complicated by PPROM, thus enabling proper sample size calculation for future powered randomized controlled trial. STUDY DESIGN Pilot unblinded randomized controlled trial (1:1 allocation ratio). Simple random allocation sequence generated by the investigators and implemented by sequentially numbered sealed envelopes.
“Good obstetrics” revisited: Too many evidence-based practices and devices are not used
International Journal of Gynecology & Obstetrics, 2006
Introduction: As countries are designing and implementing strategies to address maternal and newborn mortality and morbidity (Millennium Development Goals 5 and 4), it appears that a large number of evidence-based obstetric practices are not used in many settings, and this is a major obstacle to the improvement of quality obstetric care. Objectives: To remind readers of the existing, relatively easy-toimplement, evidence-based interventions that are currently not being universally applied in obstetric care and, second, to foster research to expand the evidence base further for obstetric care practices and devices, especially those that could be used in resource-poor settings. Methods: We review possible reasons why changes into practices are difficult to obtain, and we list the key evidence-based interventions known to effectively deal with the main obstetric complications, with supporting references and sources of documentation. We also list some promising interventions that require more research before being recommended. Conclusion: Professionals and health services managers have a crucial role in producing the best quality obstetric and neonatal care through implementing the listed evidence-based interventions and make them accessible to all pregnant women and their newborns without delay, even in poor settings. Reasons for which progress is slow should be addressed. One of these reasons being the lack of access
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