Bed Rest in Pregnancy

Nursing times

RN (Adult), RMN; all are lecturers, School of Health Science, Swansea University. TRACT Knight, J. et al (2009) Effects of bedrest 1: cardiovascular, respiratory and haematological systems. Nursing Times; 105: 21, early online publication.

Reviews, 1996

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.

Cochrane Database of Systematic Reviews, 2004

Birth, 2007

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.

2015

The objectives of this study were to evaluate the efficacy of two separate countermeasures, exercise and protein supplementation, to prevent muscle strength and lean tissue mass losses during 60 days of bed rest (BR) in women and whether countermeasure efficacy was influenced by pre-BR muscular fitness (strength, endurance, tissue mass). Twenty-four women were assigned to an exercise (EX, n ϭ 8), a no-exercise control (CON, n ϭ 8), or a no-exercise protein supplementation group (PROT, n ϭ 8). EX performed supine treadmill exercise within lower body negative pressure 3-4 days/wk and maximal concentric and eccentric supine leg-and calf-press exercises 2-4 days/wk. PROT consumed a diet with elevated protein content compared with CON and EX (1.6 vs. 1.0 g•kg Ϫ1 •day Ϫ1 ). Knee and calf isokinetic strength and endurance, isotonic leg-press strength, and leg lean mass were measured before and after BR. Post-BR knee extensor strength and endurance, ankle strength, and leg lean mass were significantly greater and leg-press strength tended to be higher in EX than in CON and PROT. Post-BR measures in PROT were not different than those in CON. Exercise countermeasure efficacy was less, and strength, endurance, and leg lean mass losses in CON and PROT were greater, in subjects who were more fit pre-BR. An exercise protocol combining resistive and aerobic exercise training protects against losses in strength, endurance, and leg lean mass in women during BR, while a nutritional countermeasure without exercise was not effective. Exercise countermeasures may require individualization to protect higher levels of strength and endurance. muscle strength; muscle endurance; treadmill exercise within LBNP; flywheel exercise; spaceflight; nutrition ALTHOUGH THE PHYSICAL FITNESS requirements for critical tasks during spaceflight and exploration missions are not yet defined, it is assumed that relatively high levels of muscle strength and endurance will be required during prolonged orbital and planetary exploration missions. Astronauts must be capable of safely performing microgravity and partial gravity extravehicular activities and, if required, an emergency egress from the space habitat or spacecraft. Our laboratory (16, 27) and others (24, 44) have reported that exposure to long-duration spaceflight and bed rest, a spaceflight analog, significantly decreases muscle volume or mass, strength, and endurance. In spaceflight, these decrements occur despite performance of exercise

Journal of midwifery and reproductive health, 2018

Background & aim: pregnancy is a normal part of life, however, high-risk pregnancy that need bed rest can be stressful and affect woman and her family. Therefore, understanding the needs of women on bed rest seems to be necessary to enhance the quality of care services. The present study was conducted to investigate the women's needs on bed rest during high-risk pregnancy and postpartum period. Methods: This qualitative study was performed among women with high-risk pregnancy using purposeful sampling method. Data were collected by conducting 31 semi-structured interviews with 21 pregnant women, 10 spouses, and 7 medical staff involved in their healthcare. Data analysis was carried out using conventional content analysis developed by Hsieh and Shannon. Results: According to the results, there were four main categories of needs entailing the need for psychosocial support, support for family and personal affairs, support for looking after children, and the need for economic support. The final category was the need for comprehensive support. Conclusion: The personal and family life of pregnant women is affected during bed rest. Accordingly, comprehensive support is needed to enable women to cope with these problems. To reach this goal, the provision of family-centered support services based on coordination among health sections, supporting organizations, charities, social workers, and systems providing psychological and consultation services are recommended.

Introduction: Preterm premature rupture of membranes (PPROM) i.e. rupture of membranes before 37 weeks of gestation occurs in 3% of pregnancies. The management generally include bed rest in cases of PPR0M, though the guidelines do not mention about the antepartum bed rest, however the general practice is to put the patients on bed rest. As there was no prospective study with role of bed rest in cases of PPROM at that time, our study was planned to evaluate the role of bed rest on outcome in pregnancies complicated by PPROM. Methods: The present study was randomized controlled trial. Study subjects were pregnant women with 26-34 weeks of gestation with PPROM. In addition to routine investigations, complete blood count, urine for culture/sensitivity and high vaginal swabs were taken. All the patients were managed as per hospital protocol and admitted till delivery. Patients were randomized into two groups i.e. bed rest and activity group by computer generated random numbers• Results: Mean AFI at the time of admission in bed rest and activity group was. 7.38±3.39 and 6.63±2.63 cm (p-value=0.34). Mean BPS at the time of admission in bed rest and activity group was 7.47±0.90 and 7.60±0.81respectively (p=0.55). Mean AFI after the intervention in bed rest and activity group was. 7.59±0.95 and 7.57±0.81cm (p-value=0.29). Mean BPS after the intervention in bed rest and activity group was 7.59±0.95 and 7.57±0.81 respectively (p=0.93). Conclusion: Present randomized controlled trial of effect of bed rest on preterm premature rupture of membrane revealed that bed rest have no role in prolongation of pregnancy and activity does not affect latency period too.

Journal of Applied Physiology, 2014

Lee SM, Schneider SM, Feiveson AH, Macias BR, Smith SM, Watenpaugh DE, Hargens AR. WISE-2005: Countermeasures to prevent muscle deconditioning during bed rest in women. The objectives of this study were to evaluate the efficacy of two separate countermeasures, exercise and protein supplementation, to prevent muscle strength and lean tissue mass losses during 60 days of bed rest (BR) in women and whether countermeasure efficacy was influenced by pre-BR muscular fitness (strength, endurance, tissue mass). Twenty-four women were assigned to an exercise (EX, n ϭ 8), a no-exercise control (CON, n ϭ 8), or a no-exercise protein supplementation group (PROT, n ϭ 8). EX performed supine treadmill exercise within lower body negative pressure 3-4 days/wk and maximal concentric and eccentric supine leg-and calf-press exercises 2-4 days/wk. PROT consumed a diet with elevated protein content compared with CON and EX (1.6 vs. 1.0 g·kg Ϫ1 ·day Ϫ1 ). Knee and calf isokinetic strength and endurance, isotonic leg-press strength, and leg lean mass were measured before and after BR. Post-BR knee extensor strength and endurance, ankle strength, and leg lean mass were significantly greater and leg-press strength tended to be higher in EX than in CON and PROT. Post-BR measures in PROT were not different than those in CON. Exercise countermeasure efficacy was less, and strength, endurance, and leg lean mass losses in CON and PROT were greater, in subjects who were more fit pre-BR. An exercise protocol combining resistive and aerobic exercise training protects against losses in strength, endurance, and leg lean mass in women during BR, while a nutritional countermeasure without exercise was not effective. Exercise countermeasures may require individualization to protect higher levels of strength and endurance. muscle strength; muscle endurance; treadmill exercise within LBNP; flywheel exercise; spaceflight; nutrition

European Journal of Clinical Investigation, 2014

Background Although there is no direct evidence, it is generally believed that bed rest shifts the haemostatic system towards hypercoagulability; thus, immobilized patients are commonly treated with anticoagulants. We therefore aimed to investigate whether long-term bed rest actually leads to an elevated risk for thromboembolic events. Materials and methods Eleven healthy men were enrolled in our study (bed rest campaign in MEDES Clinique d'Investigation, Toulouse, France). Besides various standard laboratory methods, we used calibrated automated thrombography (CAT) and thrombelastometry (TEM). Activation of samples with minute amounts of relipidated tissue factor allowed sensitive detection of hyper-or hypocoagulable states. Results CAT and TEM values were not indicative of bed rest-induced hypercoagulability. On the contrary, several parameters were indicative of a tendency towards a hypocoagulable state. Peak and thrombin formation velocity (VELINDEX) were significantly decreased during bed rest compared to baseline. Coagulation times were significantly increased and alpha angles were significantly decreased, indicating attenuated clot formation. Moreover, F1 + 2 and thrombin/antithrombin complex (TAT) values were significantly decreased during bed rest, indicating suppressed coagulation activation. FVII plasma levels were also significantly decreased during the first week of bed rest. Conclusions Our data indicate that the re-ambulation period is associated with a tendency towards hypercoagulability: ttPeak and StartTail were significantly shorter, Peak and VELINDEX were significantly higher compared to baseline. Moreover, plasma levels of F1 + 2, TAT, FVII and FVIII were significantly higher compared to baseline. The results from our study suggest that bed rest by itself is not associated with hypercoagulable states in healthy subjects.