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Re: triples y reposo
From: ronniem@vtr.net
Thu Oct 3 07:37:35 2002
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....gracias doctora...las hojas vuelven a brotar.ronnie
>
> De: "Dra. Alicia M. Lapidus" <alapi@fibertel.com.ar>
> Fecha: 2002/10/02 mié PM 12:50:29 GMT-04:00
> Para: Multiple recipients of list OBGIN-L <obgin-l@mail.medispecialty.com>
> Asunto: RE: triples y reposo
>
> Poniendo un poquito de sal en la discusión, acá les traigo un resumen de la
> Cochrane Database
> Author
> Crowther, CA
>
> Title
> 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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