BED REST IN PREGNANCY

Objective: To summarize existing data about the effectiveness of bed r est when used to improve various pregnancy outcomes and to determine h ow often bed rest is used and the cost associated with its use. Data s ources: We used the MEDLINE data base to search for all English langua ge papers evaluating the effectiveness of bed rest in pregnancy. We al so reviewed a number of textbooks and the 1988 National Infant Mortali ty Survey. Methods of study selection: We reviewed these sources for r ecommendations about using bed rest in various obstetric conditions. W e used the 1988 National Infant Mortality Survey to determine how ofte n bed rest was used either to prevent or to treat various obstetric co nditions and estimated the costs associated with its use. Data extract ion and synthesis: Bed rest is used in nearly 20% of all pregnancies t o prevent or treat a wide variety of conditions, including spontaneous abortion, preterm labor, fetal growth retardation, edema, chronic hyp ertension, and preeclampsia. There is little evidence of effectiveness . The estimated costs associated with bed rest, including hospitalizat ion, lost wages, and lost domestic productivity, range from more than $250 million to billions of dollars per year. Conclusions: Bed rest is used extensively to treat a wide variety of pregnancy conditions, at substantial cost but with little proof of effectiveness. We recommend that because this intervention has failed the test of effectiveness, i ts use during pregnancy should be curtailed unless randomized trials d emonstrate improvement in a specific outcome.