A Randomized Multicenter Study to Determine the Efficacy of Activity Restriction for Preterm Labor Management in Patients Testing Negative for Fetal Fibronectin

Elliott, John P.; Miller, Hugh; Coleman, Suzanne; Rhea, Debbie; Abril, Diana; Hallbauer, Karen; Istwan, Niki; Stanziano, Gary

doi:10.1038/sj.jp.7211359

Cited by 37 publications

(27 citation statements)

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“…2 Similarly, activity restriction has been widely studied for preterm birth prophylaxis and treatment. [3][4][5] Activity restriction takes many forms, including pelvic rest, work stoppage, and bed rest. None of these variations is known to be efficacious, and each may be associated with adverse social, economic, and health consequences.…”

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confidence: 99%

Activity Restriction Among Women With a Short Cervix

Grobman

Gilbert

Iams

et al. 2013

Obstetrical &Amp; Gynecological Survey

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OBJECTIVE-To estimate determinants of and outcomes associated with activity restriction among women with a short cervix.METHODS-This was a secondary analysis of a randomized trial of 17-α hydroxyprogesterone caproate for prevention of preterm birth among nulliparous women with singleton gestations and cervices less than 30 mm by midtrimester ultrasonography. Women were asked weekly whether they had been placed on pelvic, work, or nonwork rest. "Any activity restriction" was defined as being placed on any type of rest. Factors associated with any activity restriction were determined and the association between preterm birth and activity restriction was estimated with multivariable logistic regression.RESULTS-Of the 657 women in the trial, 646 (98%) responded to questions regarding activity restriction. Two hundred fifty-two (39.0%) were placed on any activity restriction at a median of 23.9 weeks (interquartile range 22.6-27.9 weeks).Women on activity restriction were older, more Dr. Spong, and Dr. Rouse, Associate Editors of Obstetrics & Gynecology, were not involved in the review or decision to publish this article.Presented at the Society for Maternal-Fetal Medicine meeting, February 11-16, 2013, San Francisco, California. Financial DisclosureThe authors did not report any potential conflicts of interest. likely to have private insurance, less likely to be Hispanic, had a shorter cervical length, and were more likely to have funneling and intra-amniotic debris. Preterm birth at less than 37 weeks of gestation was more common among women placed on activity restriction (37% compared with 17%, P<.001). After controlling for potential confounding factors, preterm birth remained more common among those placed on activity restriction (adjusted odds ratio 2.37, 95% confidence interval 1.60-3.53). Results were similar for preterm birth at less than 34 weeks of gestation. NIH Public AccessCONCLUSION-Activity restriction did not reduce the rate of preterm birth in asymptomatic nulliparous women with a short cervix.Preterm birth remains a leading cause of perinatal morbidity and mortality. 1 In an effort to reduce its frequency, investigators have studied a wide variety of prophylactic and therapeutic strategies such as antibiotics, intravenous fluids, and both short-term and longterm tocolysis. None of these strategies, however, has been proven to reduce the frequency of preterm birth. 2Similarly, activity restriction has been widely studied for preterm birth prophylaxis and treatment. [3][4][5] Activity restriction takes many forms, including pelvic rest, work stoppage, and bed rest. None of these variations is known to be efficacious, and each may be associated with adverse social, economic, and health consequences. 6,7 Two randomized trials have demonstrated that vaginal progesterone, when administered to women found to have a short cervix on transvaginal ultrasonography, reduces the frequency of preterm birth. 8,9 Accordingly, some have advocated for midtrimester cervical length screening for all pregnant wo...

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confidence: 99%

Activity Restriction Among Women With a Short Cervix

Grobman

Gilbert

Iams

et al. 2013

Obstetrical &Amp; Gynecological Survey

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“…In their trial, Elliott et al . found no difference in pregnancy outcomes or incidence of preterm birth between women who were ambulatory and those with restricted activity 39. Due to the low likelihood of delivery in both groups given the negative fetal fibronectin test result, it is difficult to determine if this lack of difference was truly due to activity level.…”

Section: Clinical Conditions For Which Bed Rest Is Prescribedmentioning

confidence: 96%

Bed Rest in Pregnancy

Bigelow

Stone

2011

Mount Sinai J Medicine

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The use of bed rest in medicine dates back to Hippocrates, who first recommended bed rest as a restorative measure for pain. With the formalization of prenatal care in the early 1900s, maternal bed rest became a standard of care, especially toward the end of pregnancy. Antepartum bed rest is a common obstetric management tool, with up to 95% of obstetricians utilizing maternal activity restriction in some way in their practice. Bed rest is prescribed for a variety of complications of pregnancy, from threatened abortion and multiple gestations to preeclampsia and preterm labor. Although the use of bed rest is pervasive, there is a paucity of data to support its use. Additionally, many well-documented adverse physical, psychological, familial, societal, and financial effects have been discussed in the literature. There have been no complications of pregnancy for which the literature consistently demonstrates a benefit to antepartum bed rest. Given the well-documented adverse effects of bed rest, disruption of social relationships, and financial implications of this intervention, there is a real need for scientific investigation to establish whether this is an appropriate therapeutic modality. Well-designed randomized, controlled trials of bed rest versus normal activity for various complications of pregnancy are required to lay this debate to rest once and for all.

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“…However, AR has not been proven to have any preventive effect [2,6,7,26,29] , but it is associated with several adverse effects [11,12,25] such as venous thromboembolism [10] ; depression, mental stress, and psychosocial effects [13 -15, 34] ; and a decrease in bone mineral density [21] and muscle mass [16] .…”

Section: Introductionmentioning

confidence: 99%