Bed Rest in Pregnancy

Abstract

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.

Pravastatin improves pregnancy outcomes in obstetric antiphospholipid syndrome refractory to antithrombotic therapy

“…Some women in this study were put on bed rest. While some studies suggest this might help control BP, there are no data to support the benefit of bed rest in prolonging gestation (41).…”

The support needs of high-risk antenatal patients in prolonged hospitalisation

“…Bed rest is a very common obstetrical management to restrict maternal activity even though there is minimal evidence that it decreases the risk of preterm delivery (Maloni, 2010). In addition Bigelow and Stone (2011) reviewed existing studies and found that there are no complications of pregnancy for which bed rest is consistently shown to be a beneficial intervention. A lack of objective research and randomised controlled trials analysing bed rest for a variety of complications of pregnancy is a major reason why up to 95% of obstetricians prescribe bed rest in their daily practice (Sciscione, 2010).…”

“…The hospital environment has also been shown to lead to depression (Thakur and Blazer, 2008). Many women contribute a substantial portion of the family income and multiple studies have shown that prolonged hospitalisation puts the majority of families under some degree of financial strain (Bigelow and Stone, 2011).…”

“Therapeutic” Bed Rest in Pregnancy

“…2,9 In addition to the lack of demonstrable benefit, they highlight the potential harms, including venous thrombosis, bone demineralization, muscle atrophy, maternal weight loss, and maternal psychological problems.…”

“…Ironically, most specialists reported that they expected little to no benefit from the intervention. 2 Because of this continuing paradox, we will summarize the relevant literature, consider the explanations for the persistence of bed rest, and describe the ethical implications of its continued use.…”