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Re: triples y reposo
From: Dra. Alicia M. Lapidus (alapi@fibertel.com.ar)
Wed Oct 2 11:47:42 2002
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Poniendo un poquito de sal en la discusión, acá les traigo un resumen de la Cochrane Database Author Crowther, CATitle Hospitalisation and bed rest for multiple pregnancy.
Source Cochrane Database of Systematic Reviews. Issue 3, 2002.
Abstract Background:
Bed rest used to be widely advised for women with a multiple pregnancy.
Objectives:
The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes.
Search strategy:
The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of relevant articles were searched. Date of last search: August 2000.
Selection criteria:
Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred.
Data collection and analysis:
Assessment for inclusion and methodological quality of the trials was done by the reviewer. Data were extracted by the reviewer and double entered. All eligible trials were included in the initial analysis. Prespecified sensitivity analyses have been carried out to evaluate the effect of trial quality, the effects of hospitalisation for bed rest in women with an uncomplicated twin pregnancy, in women with a triplet pregnancy and in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour.
Main results:
Six trials were included which involved over 600 women and 1400 babies.
(1) Analyses of all trials.
Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was a trend to a decreased number of low birth weight infants born to women in the routinely hospitalised group, which became significant when the trial using alternate allocation was excluded (odds ratio (OR) 0.79; 95% confidence interval (CI) 0.63-0.99). No differences were seen in the number of very low birth weight infants. No support for the policy was found in other neonatal outcomes. No information is available on developmental outcomes for infants in any of the trials. Women's views about the care they received were reported rarely.
(2) Analyses of hospitalisation for bed rest in women with an uncomplicated twin pregnancy.
The risk of preterm birth was not reduced. Indeed significantly more women gave birth very preterm (< 34 weeks gestation) (OR 1.84; 95% CI 1.01-3.34). No differences were seen in perinatal mortality, or in other neonatal outcomes.
Women receiving hospitalisation for bed rest had a decreased risk of developing hypertension (OR 0.55; 95% CI 0.32-0.97), although this effect was no longer apparent when the trial using alternate allocation was excluded.
(3) Analyses of hospitalisation for bed rest in women with a triplet pregnancy.
Most of the comparisons made between the hospitalised and control groups suggest beneficial treatment effects from routine hospitalisation for bed rest. However all the differences observed between the experimental and control groups were compatible with chance variation.
(4) Analyses of hospitalisation for bed rest in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour.
No differences were seen in the risk of preterm birth, perinatal mortality, fetal growth or in other neonatal outcomes.
Conclusions:
There is currently not enough evidence to support a policy of routine hospitalisation for bed rest in multiple pregnancy. No reduction in the risk of preterm birth or perinatal death is evident, although there is a suggestion that fetal growth is improved. For women with an uncomplicated twin pregnancy the results of this review suggest that it may be harmful in that the risk of very preterm birth is increased. Until further evidence is available to the contrary, the policy cannot be recommended for routine clinical practice.
-- Dra. Alicia M. Lapidus alapi@fibertel.com.ar Buenos Aires Argentina-----Original Message----- From: obgin-l@obgyn.net [mailto:obgin-l@obgyn.net] On Behalf Of Carlos Brito Sent: Martes, 01 de Octubre de 2002 10:23 p.m. To: Multiple recipients of list OBGIN-L Subject: triples y reposo
Solo para complementar la opinion. saludos
April 1998 * Volume 178 * Number 4 Perinatal outcome associated with outpatient management of triplet pregnancy OBJECTIVE: Our goal was to compare the lengths of hospitalization and the perinatal outcomes of triplet pregnancies managed with either outpatient or inpatient third-trimester bed rest. STUDY DESIGN: Thirty-two triplet pregnancies in which outpatient bed rest was prescribed (April 1993 to April 1996) were compared with a historic cohort of 34 triplets (January 1985 to March 1993) in which routine hospitalization was undertaken in the third trimester. Length of hospitalization and maternal and neonatal outcome parameters were compared between groups. RESULTS: Maternal inpatient hospital days were significantly reduced for the group managed as outpatients, but combined maternal and neonatal hospitalization was similar between groups. The mean gestational age at delivery was 1 week greater in the hospitalized cohort (33.5 ± 2.8 vs 32.5 ± 2.8, respectively; p = 0.16), and average birth weight was correspondingly greater in hospitalized cases (1942 gm vs 1718 gm, p < 0.005). Neonatal lengths of stay were similar between groups, reflecting earlier postnatal discharge in the outpatient era of this study. Preeclampsia occurred with greater frequency in the outpatient group (31.3% vs 8.8%, p = 0.02), and the neonatal complication of intraventricular hemorrhage occurred more commonly in this cohort as well(10/96 vs 1/102, p = 0.004). All other maternal and neonatal complications were similar between groups. CONCLUSION: Reduction in the length of hospitalization attributable to outpatient management was limited to the maternal length of stay. It is possible that the observed maternal and neonatal complications in the outpatient group may have been related to less rigorous bed rest. We would suggest that the differences noted in preeclampsia, birth weight, and intraventricular hemorrhage support prospective evaluation of bed rest in triplet pregnancy. (Am J Obstet Gynecol 1998;178:843-7.)
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