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Choosing Wisely: Bedrest—A Panacea for All That Ails the Gravida?

  • Venu Jain
    Correspondence
    Corresponding author: Dr. Venu Jain, Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Edmonton, AB.
    Affiliations
    Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Edmonton, AB
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Published:April 30, 2019DOI:https://doi.org/10.1016/j.jogc.2019.03.004

      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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