OB-GYN-L Messages for October, 2007: Re: Pretem labor and bedrest

Re: Pretem labor and bedrest

From: Ronald Ainsworth

ainsron@sbcglobal.net

Tue Oct 9 07:51:11 2007

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.

>
> 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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