We found no strong evidence that bed rest in hospital for women with a multiple pregnancy decreases the risk of a preterm birth. Multiple pregnancies have a higher risk of preterm (early) birth and poor growth of the babies than a single pregnancy. Bed rest during the latter half of pregnancy has been widely used as a policy for women carrying more than one baby. This was to reduce the risk of preterm birth and restricted fetal growth and to improve the health of both the mother and her babies. We identified seven controlled trials involving 713 women who were randomly offered bed rest in hospital or only admitted to hospital if complications occurred, and 1452 babies. In five of the trials the women were carrying twins, triplets in the other two trials.
Bed rest did not show benefits for women with an uncomplicated twin pregnancy. Overall, routine bed rest in hospital for multiple pregnancies did not reduce the risk of preterm birth or perinatal deaths. There was a suggestion of a decrease in the number of low birthweight infants (less than 2500 g) when women were routinely hospitalised. Only one trial provided information about what women thought about their care in the routinely hospitalised group. While a small number appreciated admission, a number found it psychologically distressing. Four of the seven trials were conducted in Harare, Zimbabwe.
The review of trials found routine bed rest in hospital did not decrease the risk of a preterm birth, but may improve growth of the infants. Benefits of bed rest in hospital for women with triplets were seen but these could equally have been due to chance.