Bed rest during pregnancy for preventing miscarriage

Aleman A, Althabe F, Belizán JM, Bergel E

Published Online:

October 6, 2010

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.

Abstract (click to read)

Background:

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 strategy:

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We included all published, unpublished and ongoing randomized trials with reported data which compare clinical outcomes in pregnant women who were prescribed bed rest in hospital or at home for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.

This record should be cited as:

Aleman A, Althabe F, Belizán JM, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003576. DOI: 10.1002/14651858.CD003576.pub2

Assessed as up to date:

May 5, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Pregnancy and Childbirth Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is bedrest for risk of miscarriage?

Bottom line:

There is insufficient evidence bedrest in hospital or at home prevents miscarriage in women with confirmed foetal viability and vaginal bleeding in the first half of pregnancy. In 1 trial there was a higher risk of miscarriage in those women in the bedrest group than in those in a human chorionic gonadotrophin therapy group with no bedrest.

Caveat:

The small number of participants in the studies reviewed is a major factor contributing to the inconclusive findings. There is currently no evidence to provide reassurance about recommending bedrest for preventing miscarriage since none of the studies assessed potential side effects of bedrest (thromboembolic events, maternal stress, depression and costs).

Context:

Miscarriage happens in 10–15% of pregnancies depending on maternal age and parity. It is associated with chromosomal defects in about half or two-thirds of cases. Many interventions have been used to prevent miscarriage but bedrest is probably the most commonly prescribed in cases of threatened miscarriage and for those with a history of previous miscarriage.

Cochrane Systematic Review:

Aleman A et al. Bed rest during pregnancy for preventing miscarriage. Cochrane Reviews, 2010, Issue 10. Article No. CD003576. DOI: 10.1002/14651858.CD003576.pub2. This review contains 2 studies involving 84 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Pregnancy & childbirth > Miscarriage > Prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Bed rest during pregnancy for preventing miscarriage

More like this

Copyright © 2011 - The Cochrane Collaboration