The effect of bedrest in hospital on fetal outcome in pregnancies complicated by intra‐uterine growth retardation

Abstract

A prospective study was made to evaluate whether bedrest in hospital is beneficial in pregnancies where intra-uterine growth retardation (IUGR) was suspected. Diagnosis was based on routine fetometry at 32 weeks of gestation, in conjunction with general ultrasound screening. 107 patients with suspected IUGR-pregnancies were divided into two groups, 49 in a hospital bedrest group and 58 in an 'out-patient' group. Fifteen women in the bedrest group refused hospitalization, and 8 women in the out-patient group had to be hospitalized for medical reasons other than suspected growth retardation, leaving 79% of the women in their allocated group. The women in the bedrest group were hospitalized for a mean duration of 29.2 days (range 5-54). The results suggest that bedrest in hospital is not beneficial, either to fetal growth or to pregnancy outcome.

Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol

“…Since no treatment has been demonstrated to be of benefit in growth restriction [75,76,77,78,79], assessment of fetal well-being and timely delivery remain as the main management strategy. The aim behind a clinical protocol for managing FGR is to combine existing evidence on various methods for monitoring fetal well-being in order to establish the risks of fetal injury or death, and to balance them against the risks of prematurity if the fetus is delivered.…”

The most frequent prescription in Obstetrics: Bed Rest!

“…We came across a single trial by Laurin in 1987, comparing birth weight among women on bed rest with ambulant but off work women. It was a small study involving 107 pregnant women, which reported that no differences were detected between bed rest and ambulatory management for fetal growth parameters (relative risk 0.43, 95% confidence interval: 0.15 to 1.27) and neonatal outcomes [18]. The study was too small to be accepted as concrete evidence for medical advice.…”

Intrauterine Blood Flow and Postnatal Neurological Development in Growth-Retarded Fetuses

“…The degree of intrauterine and neonatal morbidity was found to be reflected in patho logical changes of the fetal aortic blood veloc ity [24,25,27], Furthermore, a relationship has been found to exist between the mean fetal aortic velocity and the degree of fetal hypoxia, hypercapnia, acidosis, and hyperlactemia, as diagnosed in blood samples ob tained by cordocentesis in growth-retarded fe tuses [28],…”

“…Since the late 70s, the Malmö Research Group [23,24,26,29] has systematically studied the fetal and uteroplacental blood flow in pregnancies suspected of IUGR. In one of the first prospective studies performed in Malmö during 1981 -1983, the blood veloc ity in the fetal thoracic descending aorta was serially recorded in 159 fetuses found to be SGA according to the routine fetometry dur ing the 33rd week of gestation [24], From this group, 74 infants were born with true IUGR.…”

“…This finding in umbilical artery and/or fetal descending aorta has been shown to correlate well with an unfavorable outcome of pregnancy [22,23], Our group evolved a semiquantitative method of assessing the waveform, four blood flow classes (BFC) be ing defined to describe the appearance of the waveform, with emphasis on its diastolic part [24], These classes are as follows: BFC 0 (nor mal): positive flow throughout the heart cycle and a normal PI; BFCI: positive flow through out the cycle and a PI > mean ± 2 SD of normal; BFC II; nondetcctable end-diastolic velocity; BFC III: absence of positive flow throughout the major part of the diastole and/ or reverse flow in diastole. Another approach to the description of the aortic or umbilical velocity waveform which has also been adopted in a clinical context is a simple quali tative evaluation of the presence or absence of the end-diastolic aortic velocity [25,26],…”