The most frequent prescription in Obstetrics: Bed Rest!
Keywords:
bed rest, preeclampsia, preterm, miscarriage, reduced AFI, multiple pregnancy, ART
Abstract
The most frequent prescription across all medical disciplines and specially in Obstetrics has been bed rest. Even in this age of evidence based medicine, bed rest remains as the most prescribed, although evidence does not support it. The usage is strong because there are no substantial randomised trials to either refute or support bed rest, beginning with lack of definition. In this article we are reviewing bed rest in early miscarriage, hypertensive disorders of pregnancy, multiple pregnancy, preterm, reduced AFI, impaired fetal growth and in pregnancy after artificial reproduction techniques. We found that while women with moderate risk to preeclampsia, low AFI or multiple gestation may demonstrate some beneficial effects, it largely remains a tool for enforcing psychological benefit. It also entails adverse effects like muscle atrophy, stress and economic loss. However till more evidence can be made available, it will retain its numero uno position. DOI: 10.21276/AABS.2017.1310References
1. Maloni JA. Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstet Gynecol. 2011 July 1; 6(4): 385–393.
2. Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management, BMJ 2004;329:152–5.
3. Lapple M. Occupational factors in spontaneous miscarriage. Zentralblatt fur Gynakologie 1990;112(8):457–66.
4. Everett C, Ashurst H, Chalmers I. Reported management of threatened miscarriage by general practitioners in Wessex. BMJ 1987; 295: 583-6
5. Aleman A, Althabe F, Belizán J, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003576. [PMID: 15846669]
6. al-Sebai MA, Diver M, Hipkin LJ. The role of a single free beta-human chorionic gonadotrophin measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability. Hum Reprod 1996;11:881-8
7. Goldenberg R, Cliver S, Bronstein J, Cutter G, Andrews W, Mennemeyer S. Bed rest in pregnancy. Obstetrics & Gynecology 1994;84:131–6.
8. Duley L. Strict bed rest for proteinuric hypertension in pregnancy. In: The Cochrane Library, Issue 2, 1995
9. Spinapolice RX, Feld S, Harrigan JT. Effective prevention of gestational hypertension in nulliparous women at high risk as identified by the rollover test. American Journal of Obstetrics and Gynecology 1983;146:166–8.
10. Herrera JA. Nutritional factors and rest reduce pregnancy induced hypertension and pre-eclampsia in positive roll-over test primigravidas. International Journal of Gynecology & Obstetrics 1993;41:31–5
11. Dodd JM, Crowther CA. Hospitalisation for bed rest for women with a triplet pregnancy: an abandoned randomised controlled trial and meta-analysis, BMC Pregnancy and Childbirth 2005, 5:8
12. Australian Institute of Health and Welfare, National Perinatal Statis- tics Unit: Australia's mothers and babies 2000. Canberra 2003.
13. Norwitz ER, Edusa V, Park JS. Maternal physiology and complications of multiple pregnancy. Seminars in Perinatology 2005;29(5):338–48. [PUBMED: 16360493]
14. Senat MV, Ancel PY, Bouvier-Colle MH, Breart G. How does multiple pregnancy affect maternal mortality and morbidity?. Clinical Obstetrics and Gynecology 1998;41(1): 78–83. [PUBMED: 9504226]
15. Crowther CA, Han S. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD000110. DOI: 10.1002/14651858.CD000110.pub2 [PMID:20614420]
16. Elliott JP1, Miller HS, Coleman S, Rhea D, Abril D, Hallbauer K, Istwan NB, Stanziano GJ. A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin. J Perinatol. 2005 Oct;25(10):626-30
17. Hobel CJ1, Ross MG, Bemis RL, Bragonier JR, Nessim S, Sandhu M, Bear MB, Mori B. The West Los Angeles Preterm Birth Prevention Project. I. Program impact on high-risk women. Am J Obstet Gynecol. 1994 Jan;170(1 Pt 1):54-62
.
18. Laurin J, Persson PH. The effect of bedrest in hospital on fetal outcome in pregnancies complicated by intra-uterine growth retardation. Acta Obstetricia et Gynecologica Scandinavica 1987;66: 407–11.
19. Ülker K, Çeçen K, Temur İ, Gül A, Karaca M. Effects of the maternal po- sition and rest on the fetal urine production rate: a prospective study con- ducted by 3-dimensional sonography using the rotational technique (virtual organ computer-aided analysis). J Ultrasound Med 2011; 30:481– 486
20. Ülker K, Gül A, Çiçek M. Correlation Between the Duration of Maternal Rest in the Left Lateral Decubitus Position and the Amniotic Fluid Volume Increase. J Ultrasound Med 2012; 31:705–709
21. Marx GF, Patel S, Berman JA, Farmakides G, Schulman H. Umbilical blood flow velocity waveforms in different maternal positions and with epidural analgesia. Obstet Gynecol 1986; 68:61–64
22. Ryo E, Okai T, Takagi K, et al. Comparison of umbilical artery Doppler velocimetry between maternal supine position and complete left lateral position in predicting obstetric complications. Ultrasound Obstet Gynecol 1998; 11:415–418
.
23. Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI. Bed rest after embryo transfer: a randomized controlled trial. Fertility and Sterility 2007;87(6):1322–6. [PUBMED: 17362946]
24. Kovacevich GJ, Gaich SA, Lavin JP, Hopkins MP, Crane SS, Stewart J, et al.The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. American Journal of Obstetrics and Gynecology 2000;182(5):1089–92
25. Maloni JA, Chance B, Zhang C, Cohen AW, Betts D, Gange SJ. Physical and psychosocial side effects of antepartum hospital bed rest. Nursing Research 1993;42(4):197–203
26. Maloni JA, Kane JH, Suen LJ, Wang KK. Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study. Nursing Research 2002;51(2):92–9
27. Gupton A, Heaman M, Ashcroft T. Bed rest from the perspective of the high-risk pregnant woman. Journal of Obstetric, Gynecologic and Neonatal Nursing 1997;26(4): 423–30.
28. Schroeder C. Women ́ s experience of bed rest in high-risk pregnancy. Image - The Journal of Nursing Scholarship 1996; 28(3):253–8.
29. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229–33.
30. Trudel G, Payne M, Ma ̈dler B, Ramachandran N, Lecompte M, Wade C et al. Bone marrow fat accumulation after 60 days of bed rest persisted 1 year after activities were resumed along with hemopoietic stimulation: the Women International Space Simulation for Exploration study, J Appl Physiol 2009;107: 540–8
2. Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management, BMJ 2004;329:152–5.
3. Lapple M. Occupational factors in spontaneous miscarriage. Zentralblatt fur Gynakologie 1990;112(8):457–66.
4. Everett C, Ashurst H, Chalmers I. Reported management of threatened miscarriage by general practitioners in Wessex. BMJ 1987; 295: 583-6
5. Aleman A, Althabe F, Belizán J, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003576. [PMID: 15846669]
6. al-Sebai MA, Diver M, Hipkin LJ. The role of a single free beta-human chorionic gonadotrophin measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability. Hum Reprod 1996;11:881-8
7. Goldenberg R, Cliver S, Bronstein J, Cutter G, Andrews W, Mennemeyer S. Bed rest in pregnancy. Obstetrics & Gynecology 1994;84:131–6.
8. Duley L. Strict bed rest for proteinuric hypertension in pregnancy. In: The Cochrane Library, Issue 2, 1995
9. Spinapolice RX, Feld S, Harrigan JT. Effective prevention of gestational hypertension in nulliparous women at high risk as identified by the rollover test. American Journal of Obstetrics and Gynecology 1983;146:166–8.
10. Herrera JA. Nutritional factors and rest reduce pregnancy induced hypertension and pre-eclampsia in positive roll-over test primigravidas. International Journal of Gynecology & Obstetrics 1993;41:31–5
11. Dodd JM, Crowther CA. Hospitalisation for bed rest for women with a triplet pregnancy: an abandoned randomised controlled trial and meta-analysis, BMC Pregnancy and Childbirth 2005, 5:8
12. Australian Institute of Health and Welfare, National Perinatal Statis- tics Unit: Australia's mothers and babies 2000. Canberra 2003.
13. Norwitz ER, Edusa V, Park JS. Maternal physiology and complications of multiple pregnancy. Seminars in Perinatology 2005;29(5):338–48. [PUBMED: 16360493]
14. Senat MV, Ancel PY, Bouvier-Colle MH, Breart G. How does multiple pregnancy affect maternal mortality and morbidity?. Clinical Obstetrics and Gynecology 1998;41(1): 78–83. [PUBMED: 9504226]
15. Crowther CA, Han S. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD000110. DOI: 10.1002/14651858.CD000110.pub2 [PMID:20614420]
16. Elliott JP1, Miller HS, Coleman S, Rhea D, Abril D, Hallbauer K, Istwan NB, Stanziano GJ. A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin. J Perinatol. 2005 Oct;25(10):626-30
17. Hobel CJ1, Ross MG, Bemis RL, Bragonier JR, Nessim S, Sandhu M, Bear MB, Mori B. The West Los Angeles Preterm Birth Prevention Project. I. Program impact on high-risk women. Am J Obstet Gynecol. 1994 Jan;170(1 Pt 1):54-62
.
18. Laurin J, Persson PH. The effect of bedrest in hospital on fetal outcome in pregnancies complicated by intra-uterine growth retardation. Acta Obstetricia et Gynecologica Scandinavica 1987;66: 407–11.
19. Ülker K, Çeçen K, Temur İ, Gül A, Karaca M. Effects of the maternal po- sition and rest on the fetal urine production rate: a prospective study con- ducted by 3-dimensional sonography using the rotational technique (virtual organ computer-aided analysis). J Ultrasound Med 2011; 30:481– 486
20. Ülker K, Gül A, Çiçek M. Correlation Between the Duration of Maternal Rest in the Left Lateral Decubitus Position and the Amniotic Fluid Volume Increase. J Ultrasound Med 2012; 31:705–709
21. Marx GF, Patel S, Berman JA, Farmakides G, Schulman H. Umbilical blood flow velocity waveforms in different maternal positions and with epidural analgesia. Obstet Gynecol 1986; 68:61–64
22. Ryo E, Okai T, Takagi K, et al. Comparison of umbilical artery Doppler velocimetry between maternal supine position and complete left lateral position in predicting obstetric complications. Ultrasound Obstet Gynecol 1998; 11:415–418
.
23. Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI. Bed rest after embryo transfer: a randomized controlled trial. Fertility and Sterility 2007;87(6):1322–6. [PUBMED: 17362946]
24. Kovacevich GJ, Gaich SA, Lavin JP, Hopkins MP, Crane SS, Stewart J, et al.The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. American Journal of Obstetrics and Gynecology 2000;182(5):1089–92
25. Maloni JA, Chance B, Zhang C, Cohen AW, Betts D, Gange SJ. Physical and psychosocial side effects of antepartum hospital bed rest. Nursing Research 1993;42(4):197–203
26. Maloni JA, Kane JH, Suen LJ, Wang KK. Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study. Nursing Research 2002;51(2):92–9
27. Gupton A, Heaman M, Ashcroft T. Bed rest from the perspective of the high-risk pregnant woman. Journal of Obstetric, Gynecologic and Neonatal Nursing 1997;26(4): 423–30.
28. Schroeder C. Women ́ s experience of bed rest in high-risk pregnancy. Image - The Journal of Nursing Scholarship 1996; 28(3):253–8.
29. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229–33.
30. Trudel G, Payne M, Ma ̈dler B, Ramachandran N, Lecompte M, Wade C et al. Bone marrow fat accumulation after 60 days of bed rest persisted 1 year after activities were resumed along with hemopoietic stimulation: the Women International Space Simulation for Exploration study, J Appl Physiol 2009;107: 540–8
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2017-02-21
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