Abstract
Bedrest has been frequently prescribed for various high-risk conditions during pregnancy.
A common indication cited is concern regarding increased risk of spontaneous preterm
birth, known to be associated with gestations with twins or higher-order multiples,
polyhydramnios, presence of preterm contractions with or without evidence of cervical
change, sonographic cervical shortening, presence of a dilated cervix with bulging
membranes, or preterm premature rupture of membranes. In some cases, there is concern
that excessive movement may increase the risk of antepartum hemorrhage, as may be
with placenta previa, with or without a higher risk of a morbidly adherent placenta
or a vasa previa. It is also thought that improved splanchnic perfusion with bedrest
may enhance blood supply to the uterus with possible benefit in conditions such as
preeclampsia (or gestational hypertension) or fetal growth restriction. However, there
is no evidence of any benefit of bedrest or reduced activity during pregnancy for
either of these conditions. On the contrary, there is evidence of harm, in addition
to the fact that exercise is known to be beneficial in pregnancy.
Résumé
L'alitement est fréquemment prescrit lorsqu'un problème à risque élevé survient durant
la grossesse. Une indication souvent mentionnée est le risque accru d'accouchement
prématuré spontané, une situation associée aux grossesses gémellaires et aux grossesses
multiples de rang élevé; à un hydramnios; à des contractions avant terme, avec ou
sans modification cervicale; à un raccourcissement du col observable à l'échographie;
à une dilatation du col accompagnée d'une saillie des membranes; ou à une rupture
prématurée des membranes. Dans certains cas, par exemple de placenta prævia avec ou
sans risque accru d'adhérence pathologique du placenta ou de vasa prævia, on craint
qu'un excès de mouvement augmente le risque d'hémorragie antepartum. Par ailleurs,
on croit que l'augmentation de la circulation splanchnique due à l'alitement pourrait
accroître l'apport sanguin à l'utérus et ainsi avoir une incidence positive en présence
de problèmes comme la prééclampsie (ou l'hypertension gravidique) ou le retard de
croissance fœtal. Toutefois, il n'existe aucune preuve des avantages de l'alitement
ou de la réduction de l'activité physique durant la grossesse, pour aucun de ces problèmes
de santé. Au contraire, des données indiquent une possibilité de préjudice, en plus
du fait que l'exercice est reconnu comme bénéfique durant la grossesse.
Key Words
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Article info
Publication history
Published online: April 30, 2019
Footnotes
Competing interests: The author declares that he has no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
