BED REST AND PREVENTION OF MISCARRIAGE

When I got pregnant again after my miscarriage, I suffered threatened miscarriage. The advice I received from my doctor in Nigeria was to go on bed rest till I was well into my second trimester. In fact I was on strict bed rest till I was at least 16weeks gestation.

A Cochrane review published in 2008 questions the effectiveness of bed rest, so widely prescribed as a preventive measure in cases of threatened miscarriage or past history of miscarriage. This is because bed rest suggests that hard work and exertion are causative factors in miscarriage. I personally know, from my research on the topic of miscarriage that this has not been objectively proven.

In arguing against bed rest, the reviewers state that it may do more harm than good, increasing the likelihood of thromboembolic events (pregnancy already predisposes to formation of blood clots and staying stationary may worsen matters). They also argue that enforcing bed rest might be very stressful for the woman and her family (if she has other children or responsibilities that require her to be active) and may result in self blame if the pregnancy does progress to a miscarriage as she may feel she did not comply properly with instructions and hence caused her loss; in fact, it may have been inevitable with or without bed rest.

Based on their inclusion and exclusion criteria, they had two studies to review. These two studies randomly allocated women to either bed rest at home versus bed rest in hospital +/- medication versus no bed rest. These women did not have a history of recurrent miscarriage (i.e. three or more consecutive miscarriages) and had experienced vaginal bleeding between 7 and 16 weeks gestation.

There was no significant difference in miscarriage outcomes in all the groups.

For a difference to be statistically significant the study should be able to prove that the observed differences between the two groups could not be due to chance alone but due to a specific benefit. This was not proven.

As discussed in previous posts, there is research already in progress to identify objective markers that can predict the outcome of a pregnancy with threatened miscarriage. If more research is conducted to build on this, medical practitioners will be better equipped to manage this condition in a manner that is unequivocally effective, based on specific information  on which to base prognosis. This would definitely make us more effective and make the woman and her family less stressed.

SOURCE

Aleman A, Althabe F, Belizan JM, Bergel E, Bed rest during pregnancy for preventing miscarriage, Cochrane database of systematic reviews 2005, Issue 2, Art.No.CD003576.