BED REST IN PREGNANCY


I. To reduce risk of spont. Ab or fetal loss in threatened Ab

  1. Since most aborted fetuses are chromosomally abnormal, it seems unlikely that bedrest could make a difference
  2. No data to support effectiveness
  3. Some suggest lack of effectiveness (Obs. Gyn. 2:63, 1953, cited in above review)

II. To treat gestational (transient) hypertension and chronic nonproteinuric hypertension and recurrence of preeclampsia

  1. Would hope to achieve a reduction in blood pressure and reduced risk for preeclampsia (which would in turn lower risk of preterm delivery and c/s)
  2. Bedrest seems to lower blood pressure in women with transient or chronic hypertension but not to alter other clinical parameters; may even be an increased risk for eclampsia and perinatal mortality with bedrest (3 studies, cited in above review), although one series of randomized trials showed that hospitalization (and thus probably bedrest) reduced rate of progression to severe HTN and risk of preterm delivery in women with above conditions (Br. J. Obs. Gyn 99:13, 1992; cited in below review)

III. To treat preeclampsia

  1. No randomized trials to support bedrest
  2. However, since hospitalization and intensive monitoring have become standard for preeclampsia, outcomes have improved greatly; inclear if the bedrest part of hospitalization is independently helpful

IV. To prevent preterm labor in women at high risk or with sx of preterm labor

  1. "No evidence supporting or refuting"

V. To treat IUGR

  1. Only shown effective in improving outcomes in developing countries where nutritional status improves greatly with bedrest
  2. One randomized trial (Acta Obs. Gyn Scand. 66:407, 1987, cited in above review) failed to show any benefit; nonrandomized studies have claimed to show improved outcome (Obs. Gyn. 78:1062, 1991, cited in above review)

(Source: Obs. Gyn 84:131, 1994 and others)