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Evidence summaries

Hospitalization and Bed Rest for Multiple Pregnancy

Routine hospitalization for bed rest appears not to be effective in multiple pregnancy. However, bed rest in hospital appears to increase mean birthweight compared with no restriction at home. Level of evidence: "B"

A Cochrane review [Abstract] 2 included 6 trials with a total of 636 women with a twin or triplet pregnancy (1298 babies). In comparison of strict bed rest in hospital with no activity restriction at home, there was no difference in the risk of very preterm birth (RR 1.02, 95% CI 0.66 to 1.58; 5 trials, 495 women, 1016 babies), perinatal mortality (RR 0.65, 95% CI 0.35 to 1.21; 5 trials, 1016 neonates), and low birthweight (RR 0.95, 95% CI 0.75 to 1.21; 3 trials, 502 neonates). No differences for the risk of small-for-gestational age (SGA) (RR 0.75, 95% CI 0.56 to 1.01; 2 trials, 293 women) and prelabour preterm rupture of the membrane (PPROM) (RR 1.30, 95% CI 0.71 to 2.38; 3 trials, 276 women) was observed. However, strict bed rest in hospital was associated with increased spontaneous onset of labour (RR 1.05, 95% CI 1.02 to 1.09, P = 0.004; 4 trials, 488 women) and a higher mean birthweight (mean difference (MD) 136.99 g, 95% CI 39.92 to 234.06, P = 0.006; 3 trials, 314 women) compared with no activity restriction at home.

Seven trials involving 713 women and 1 452 babies were included in a Cochrane review [Abstract] 1. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was a trend to a decreased number of low birth weight infants (less than 2500 g) born to women in the hospitalized group (OR 0.92, 95% CI 0.85 to 1.00). No differences were seen in the number of very low birthweight infants (less than 1500 g). No support for the policy was found for other neonatal outcomes. No information was available on developmental outcomes for infants in any of the trials.

For the secondary maternal outcomes reported of developing hypertension and caesarean delivery, no differences were seen. Women's views about the care they received were reported rarely.In the subgroup analyses for women with an uncomplicated twin pregnancy, with cervical dilation prior to labour with a twin pregnancy and with a triplet pregnancy, no differences were seen in any primary and secondary neonatal outcomes and maternal outcomes.

Comment: The quality of evidence is downgraded by sparse data (few events)

    References

    • Crowther CA, Han S. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database Syst Rev 2010;(7):CD000110. [PubMed]
    • da Silva Lopes K, Takemoto Y, Ota E et al. Bed rest with and without hospitalisation in multiple pregnancy for improving perinatal outcomes. Cochrane Database Syst Rev 2017;(3):CD012031.[PubMed].

Primary/Secondary Keywords