Bed rest during pregnancy for preventing miscarriage: Cochrane systematic review
Assessed as up to date: 2010/05/04
Miscarriage is pregnancy loss before 23 weeks of gestational age. It happens in 10% to 15% of pregnancies depending on maternal age and parity. It is associated with chromosomal defects in about a half or two-thirds of cases. Many interventions have been used to prevent miscarriage but bed rest is probably the most commonly prescribed especially in cases of threatened miscarriage and history of previous miscarriage. Since the etiology of miscarriage in most of the cases is not related to an excess of activity, it is unlikely that bed rest could be an effective strategy to reduce spontaneous miscarriage.Objectives
To evaluate the effect of prescription of bed rest during pregnancy to prevent miscarriage in women at high risk of miscarriage.Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010).Selection criteria
We included all published, unpublished and ongoing randomized trials with reported data which compare clinical outcomes in pregnant women who were prescribed bed rest in hospital or at home for preventing miscarriage compared with alternative care or no intervention.Data collection and analysis
Two authors independently assessed the methodological quality of included trials using the methods described in the Cochrane Reviewers' Handbook. Studies were included irrespective of their methodological quality.Main results
Only two studies including 84 women were identified. There was no statistically significant difference in the risk of miscarriage in the bed rest group versus the no bed rest group (placebo or other treatment) (risk ratio (RR) 1.54, 95% confidence interval (CI) 0.92 to 2.58). Neither bed rest in hospital nor bed rest at home showed a significant difference in the prevention of miscarriage. There was a higher risk of miscarriage in those women in the bed rest group than in those in the human chorionic gonadotrophin therapy group with no bed rest (RR 2.50, 95% CI 1.22 to 5.11). It seems that the small number of participants included in these studies is a main factor to make this analysis inconclusive.Authors' conclusions
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.
Aleman Alicia, Althabe Fernando, Belizán José M, Bergel Eduardo
Bed rest during pregnancy for preventing miscarriage
Not enough evidence to say if bed rest helps in preventing miscarriage.
Miscarriage is the loss of a baby before 23 weeks of pregnancy and this can cause much distress for parents. The most common treatment used to prevent it is probably bed rest. The review of two trials, involving 84 women, found that there was not enough evidence from good quality studies to be able to say whether bed rest helps to prevent miscarriage or not. Care for women at increased risk of miscarriage needs to be offered according to their individual needs.
Implications for practice
There is not enough information to justify the recommendation of bed rest for women with threatened miscarriage or at high risk of miscarriage. There is currently no evidence to give reassurance that such a policy could not be harmful for women and their families since none of the studies assesses potential side-effects of bed rest (thromboembolic events, maternal stress, depression, costs). Until further evidence is available the policy of bed rest cannot be recommended for routine clinical practice for women with threatened miscarriage or at high risk of miscarriage.
Implications for research
Bed rest for threatened miscarriage was introduced into clinical practice without adequate controlled evaluation of its efficacy. The policy has been subjected to limited well-controlled evaluation, and to clarify further the beneficial or adverse effects, additional, controlled evaluation is necessary. Evaluation of the policy in women considered at high risk of miscarriage (women with a threatened miscarriage or with a previous history of miscarriage excluding women with recurrent miscarriages) would seem appropriate. Also, a further assessment of the potential favorable effects of human chorionic gonadotrophin is necessary. Any future trials that study the effect of bed rest in women at high risk of miscarriage, should evaluate thromboembolic events, women's satisfaction, psychological adjustment and costs. Long-term follow up of developmental outcome of infants should also be studied.Get full text at The Cochrane Library
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