Re: Pretem labor and bedrest
From: art fougner, md (evsono@pipeline.com)
Tue Oct 9 11:46:37 2007
To amplify your point, Ron, bedrest in pregnancy may even violate
"Primum non nocere."
Am J Obstet Gynecol. 2004 Oct;191(4):1077-83.
Bed rest and other determinants of bone loss during pregnancy.
Promislow JH, Hertz-Picciotto I, Schramm M, Watt-Morse M, Anderson JJ.
Department of Epidemiology, School of Public Health, University of North
Carolina, Chapel Hill, NC, USA. promisl1@niehs.nih.gov
OBJECTIVE: The purpose of this study was to evaluate patterns of bone
loss during pregnancy and potential influences. STUDY DESIGN: This was
a prospective study of 181 women receiving prenatal care at Magee-Womens
Hospital or its auxiliary clinics in Pittsburgh, Pennsylvania, between
1992 and 1995. Bone mineral density was measured at approximately 16
and 36 weeks' gestation. RESULTS: Trabecular, but not cortical, bone
loss occurred during pregnancy. Mean ultra-distal bone mineral density
loss was 1.9% (95% CI 1.2-2.5) during the 20-week period. Women
prescribed bed rest had an adjusted mean loss of 4.6% compared with 1.5%
for women not prescribed bed rest ( P = .001) and 6-fold higher odds ( P
= .001) of bone loss > or =5% during the 20-week period. Nulliparity,
calcium intake < 2 000 mg/day, low weight gain, and maternal age < 21 or
>30 years were more modestly associated with greater bone loss.
CONCLUSION: Substantial trabecular bone loss may occur during pregnancy,
particularly in women prescribed bed rest. Study of postpartum bone
recovery in such women is needed.
Art
At Tue, 9 Oct 2007, Ronald Ainsworth wrote:
>
>We can't because there aren't!
>
>Bed rest in singleton pregnancies for preventing
>preterm birth.
>AU Sosa C; Althabe F; Belizan J; Bergel E
>SO Cochrane Database Syst Rev 2004;(1):CD003581.
>
> BACKGROUND: Bed rest in hospital or at home is
>widely recommended for the prevention of preterm
>birth. This advice is based on the observation that
>hard work and hard physical activity during pregnancy
>could be associated with preterm birth and with the
>idea that bed rest could reduce uterine activity.
>However, bed rest may have some adverse effects on
>other outcomes. OBJECTIVES: To evaluate the effect of
>prescription of bed rest in hospital or at home for
>preventing preterm birth in pregnant women at high
>risk of preterm birth. SEARCH STRATEGY: We searched
>the Cochrane Pregnancy and Childbirth Group trials
>register (July 2003), the Cochrane Central Register of
>Controlled Trials (The Cochrane Library, Issue 2,
>2003), MEDLINE (July 2003), LILACS (July 2003), EMBASE
>(July 2003), POPLINE (July 2003) and bibliographies of
>relevant papers. SELECTION CRITERIA: Randomized and
>quasi-randomized controlled trials with reported data
>that assess clinical outcomes in women at high risk of
>spontaneous preterm birth who were prescribed bed rest
>in hospital or at home for preventing preterm birth,
>and their babies. DATA COLLECTION AND ANALYSIS: Two
>reviewers independently assessed eligibility, trial
>quality and extracted data. MAIN RESULTS: One study
>met the inclusion criteria (1266 women). This trial
>has uncertain methodological quality due to lack of
>reporting. Four hundred and thirty-two women were
>prescribed bed rest at home and a total of 834 women
>received a placebo (412) or no intervention (422).
>Preterm birth before 37 weeks was similar in both
>groups (7.9% in the intervention group versus 8.5% in
>the control group), and the relative risk was 0.92
>with a 95% confidence interval from 0.62 to 1.37. No
>other results were available. REVIEWER'S CONCLUSIONS:
>There is no evidence, either supporting or refuting
>the use of bed rest at home or in hospital, to prevent
>preterm birth. Although bed rest in hospital or at
>home is widely used as the first step of treatment,
>there is no evidence that this practice could be
>beneficial. Due to the potential adverse effects that
>bed rest could have on women and their families, and
>the increased costs for the healthcare system,
>clinicians should not routinely advise women to rest
>in bed to prevent preterm birth. Potential benefits
>and harms should be discussed with women facing an
>increased risk of preterm birth. Appropriate research
>is mandatory. Future trials should evaluate both the
>effectiveness of bed rest, and the effectiveness of
>the prescription of bed rest, to prevent preterm
>birth.
>
>--- Andrew Folley <agfolley@hotmail.com> wrote:
>
>> Can anyone direct me to a single article that shows
>> that bedrest is an established preventative measure
>> for treating women at risk of premature delivery????
>>
>> Date: Sun, 7 Oct 2007 08:44:47 -0500
>> From: agfolley@hotmail.com
>> To: ob-gyn-l@dns.obgyn.net
>> Subject: RE: Reverse Diastolic Flow At 20 Weeks
>>
>> At 20 weeks with reverse diastolic flow I think this
>> would be a very bad prognosis for the baby. Would
>> anticipate fetal demise in the next 1-3 weeks. I
>> think you would have to be looking for some type of
>> congenital cardiac anomalies. I wonder if torsion
>> of the cord could give this picture as well. as Out
>> of interest I would like to know the venous doppler
>> of the ductus venosum and the doppler flow of the
>> uterine artery. Also you would expect the baby to
>> be having centralization of flwo ot he brain as
>> eveidnece by increased diastolic flow in the Middle
>> Cerebral artery doppler.
>>
>> Date: Sat, 6 Oct 2007 19:56:47 -0500
>> From: rd.braun@gmail.com
>> To: ob-gyn-l@dns.obgyn.net
>> Subject: Re: Reverse Diastolic Flow At 20 Weeks
>>
>> Don't deliver now. (TIC)
>> Something wrong with either the fetus or the
>> machine. Wait & see.
>>
>> Dan
>>
>> On 10/5/07, Dean Huffman . < dean@thehuffpeople.net>
>> wrote:
>> .
>>
>> 20 weeks gestation with quadruple screen that shows
>> MSAFP of 3.3 MOM's. Low
>> risk
>> Down's and trisomy 18. Ultraosund completely normal
>> except reverse diastolic
>> flow on umbiical artery.
>>
>> Thoughts?
>>
>> --
>> R. Daniel Braun, MD FACOG(L) CMT
>> Professor Emeritus
>> Dept. of Obstetrics and Gynecology
>> Indiana U. School of Medicine
>>
>> R. Daniel Braun
>>
>> "Science without Religion is LAME; Religion
>> without Science is BLIND"
>> Einstein 1941
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>> Messenger Café. Stop by today!
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
