"Therapeutic" bed rest in pregnancy: unethical and unsupported by data.

@article{McCall2013TherapeuticBR,
  title={"Therapeutic" bed rest in pregnancy: unethical and unsupported by data.},
  author={Christine A. McCall and David A. Grimes and Anne Drapkin Lyerly},
  journal={Obstetrics and gynecology},
  year={2013},
  volume={121 6},
  pages={
          1305-8
        }
}
"Therapeutic" bed rest continues to be used widely, despite evidence of no benefit and known harms. In this commentary, we summarize the Cochrane reviews of bed rest and propose an ethical argument for discontinuing this practice. Cochrane systematic reviews do not support "therapeutic" bed rest for threatened abortion, hypertension, preeclampsia, preterm birth, multiple gestations, or impaired fetal growth. This assessment has been echoed in other comprehensive reviews. Prescribing bed rest is… 

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There is no evidence, either supporting or refuting the use of bed rest at home or in hospital, to prevent preterm birth, and future trials should evaluate both the effectiveness ofBed rest in hospital or at home is widely used as the first step of treatment, there are no evidence that this practice could be beneficial.

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References

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Lack of evidence for prescription of antepartum bed rest.

  • J. Maloni
  • Medicine
    Expert review of obstetrics & gynecology
  • 2011
TLDR
Research indicates that bed-rest treatment is ineffective for preventing preterm birth and fetal growth restriction, and for increasing gestational age at birth and infant birthweight, and it should be discontinued until evidence of effectiveness is found.

BED REST IN PREGNANCY

Bed rest with or without hospitalisation for hypertension during pregnancy.

TLDR
Although one small trial suggests that some bed rest may be associated with reduced risk of severe hypertension and preterm birth, these findings need to be confirmed in larger trials and bed rest should not be recommended routinely for hypertension in pregnancy.

BED REST IN PREGNANCY

TLDR
Bed rest is used extensively to treat a wide variety of pregnancy conditions, at substantial cost but with little proof of effectiveness, and its use during pregnancy should be curtailed unless randomized trials demonstrate improvement in a specific outcome.

Bed rest in hospital for suspected impaired fetal growth.

TLDR
There is not enough evidence to evaluate the use of a bed rest in hospital policy for women with suspected impaired fetal growth, according to the review of randomised trials comparing a policy of bed Rest in hospital with ambulatory management.

Hospitalisation and bed rest for multiple pregnancy.

  • C. Crowther
  • Medicine
    The Cochrane database of systematic reviews
  • 2001
TLDR
Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality, and there is currently not enough evidence to support a policy of routine hospitalisation for bed rest for women with a multiple pregnancy.

Hospitalisation and bed rest for multiple pregnancy.

  • C. Crowther
  • Medicine
    The Cochrane database of systematic reviews
  • 2000
TLDR
Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality, and there is currently not enough evidence to support a policy of routine hospitalisation for bed rest for women with a multiple pregnancy.

Bed rest in singleton pregnancies for preventing preterm birth.

TLDR
There is no evidence, either supporting or refuting the use of bed rest at home or in hospital, to prevent preterm birth, and future trials should evaluate both the effectiveness ofBed rest in hospital or at home is widely used as the first step of treatment, there are no evidence that this practice could be beneficial.

Bed rest during pregnancy for preventing miscarriage.

TLDR
There is insufficient evidence of high quality that supports a policy of bed rest in order to prevent miscarriage in women with confirmed fetal viability and vaginal bleeding in first half of pregnancy.

Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure.

TLDR
Daily rest, with or without nutrient supplementation, may reduce the risk of pre-eclampsia for women with normal blood pressure, although the reported effect may reflect bias and/or random error rather than a true effect.