Dr Dasgupta Was invited to deliver a lecture on the International Conference on HRPL (High Risk Pregnancy and Labour) Organized by Federation of Obstetric and Gynaecological Societies of India (FOGSI) at ITC Sonar Kolkata

1. Bed Rest In Pregnancy-
More Harm Than Benefit?
Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons)
MS (Obst & Gynae- Gold Medalist)
DNB (Obst & Gynae)
Assistant Professor: Gouri Devi Institute of Medical
Sciences, Durgapur
Visiting Consultant: Indian Air Force
Secretary, Bulletin & Website Committee: Bengal
Obstetric & Gynaecological Society (BOGS)- 2015-16

2. Bed Rest in Medicine
• Bed rest refers to
“voluntarily” lying
in bed as a
treatment
Silas Weir Mitchell (1880)

3. Charlotte Perkins Gilman (1892)

4. Gain of Bed Rest
Bed Rest
Hysteric
Patient
No bed rest
Productivity

5. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful
treatment needing more careful evaluation. Lancet 1999;
354:1229-33
• Lumbar puncture
• Spinal anesthesia
• Radiculography
• Cardiac catheterization
• Skin graft of burn
• Liver biopsy
• Fixation of femoral fracture
• Pressure sore surgery
• Gastric surgery
• Acute Hysteria
• Panic Disorder
• Acute low back pain
• Uncomplicated myocardial
infarction
• Pulmonary tuberculosis
• Rheumatic Fever
• Acute Viral Hepatitis
• Spontaneous labor
• Proteinuric hypertension
during pregnancy
• Early threatened abortion

6. • There is no evidence to support the use of bed rest
as therapeutic measure in modern medicine.
• Not only it is ineffective, but is associated with
physical, emotional, social and financial burdens.

7. I am not interested in
the DIAGNOSIS,
I will advise
COMPLETE BED REST
!!!!!
Something isBETTER
THANNOTHING !!!!
At leastwe are
TRYING
SOMETHING!!!!!

8. “Thereis NO HARMin Bedrest”
• Simulates physiology of
space flight
• Thrombosis
• Constipation
• Hyperacidity
• Depression and Anxiety
• Family stress
• Financial worries
• Weakened bones and
muscles

9. Bed Rest in Obstetrics
• Why wouldn’t you endure a
little extra annoyance
(you’re pregnant, after all)
if it would help keep your tiny,
oh-so-vulnerable fetus floating
inside the fortress of your
womb
as long as possible?

10. “If we have anything to learn from the history of medicine it
is that instincts and good intentions are a highly fallible
compass without the check of scientific controls.”

11. “Therapeutic” Bed Rest in Pregnancy- Unethical and
Unsupported by Data. McCall CA, Grimes DA, Lyerly AD Obstet
Gynecol 2013;121:1305–8
• Every woman receive INFORMED CONSENT
• If a woman feels that increasing her daily rest
lessens anxiety, then we are not suggesting
this should be discontinued

12. Do not try this !!!

13. Bed Rest is advised commonly in…
• Threatened Miscarriage
• Recurrent Miscarriage
• APH
• Preterm Labour
• High risk of preterm labour
• Cervical Insufficiency
• PROM
• IUGR
• Preeclampsia

14. Miscarriage

15. Rest = Glue?????

16. Cochrane Review
• Until further evidence is available the policy of
bed rest cannot be recommended for women
1. with threatened miscarriage
2. at high risk of miscarriage*
*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

17. Cochrane Review (….. Contd.)
Relative Risks
(RR)
95% of
Confidence
interval (CI)
GA of
miscarriage
Bed Rest
2.50 1.22-5.11
12 weeks
No Bed Rest 13.5 weeks

18. Bed rest after IVF
• Bed rest might negatively affect the outcome
of IVF/ICSI cycles via stress/anxiety
mechanisms*
*Craciunas L, Tsampras N. Bed rest following
embryo transfer might negatively affect the
outcome of IVF/ICSI: a systematic review and
meta-analysis. Hum Fertil (Camb). 2016 Mar
17:1-7

19. Preterm Labour

20. Cochrane Review
• Although bed rest in hospital or at home is widely
used as the first step of treatment, there is no
evidence that this practice could be beneficial*
• Potential benefits and harms should be discussed
with women facing an increased risk of preterm
birth
*Sosa CG, Althabe F, Belizán JM, Bergel E. Bed rest
in singleton pregnancies for preventing preterm
birth. Cochrane Database Syst Rev. 2015 Mar
30;3:CD003581

21. • Although bed rest and hydration have been recommended
to women with symptoms of preterm labor to prevent
preterm delivery, these measures have not been shown to
be effective for the prevention of preterm birth and should
not be routinely recommended.
• Furthermore, the potential harm, including venous
thromboembolism, bone demineralization, and
deconditioning, and the negative effects, such as loss of
employment, should not be underestimated.

22. Multiple Gestation

23. Cochrane Review
• No reduction in the risk of preterm birth or
perinatal death is evident with bed rest in
multiples
• This policy cannot be recommended for routine
clinical practice.*
*Crowther CA, Han S. Hospitalisation and bed rest
for multiple pregnancy. Cochrane Database Syst
Rev. 2010 Jul 7;(7):CD000110.

24. Cervical Insufficiency

25. To prevent premature delivery
Belief
• The reclining posture
reduces the force of
gravity on the cervix
Evidence
• Bed rest is not superior to
placebo for treatment of the
mid-trimester extremely
short cervix (≤15 mm)*
*Skupski DW, Lin SN, Reiss J,
Eglinton GS. Extremely short
cervix in the second trimester:
bed rest or modified Shirodkar
cerclage? J Perinat Med. 2014
Jan;42(1):55-9.

26. PROM

27. Theories
• Rest will reduce
the leakage and
prolong
pregnancy
• Pooling of fluid in
the vagina will
invite infection

28. • Bed rest is an ineffective method to prolong
duration of pregnancy in PROM irrespective of
the GA of leakage and so it is not
recommended.1-2
1. Biggio JR Jr. Bed rest in pregnancy: time to put
the issue to rest. Obstet Gynecol. 2013
Jun;121(6):1158-60.
2. Cardell M, Stjernholm YV. Bed rest during risk for
premature birth may do more harm than good.
Lakartidningen. 2012 Sep 5-11;109(36):1556.
Put the “Rest” to rest

29. Harms of bed rest

30. Physical Effects*
• Loss of muscle tone, calcium loss, bone demineralization
• Constipation, hyperacidity
• Fatigue
• Shortness of breath
• Delay in recovery during the postpartum period
• Glucose intolerance (Diabetes)
• Difficulty in BP control (Preeclampsia)
• Low Birth Weight Baby (IUGR)
*Dunn, L. L., Handley, M. C., & Carter, M. R. Antepartal Bed
rest: Conflicts, Costs, Controversies and Ethical
Considerations. Online Journal of Health Ethics. 2006, 3(1)

31. Emotional Effects
• Stress
• Anxiety
• Sleep Disturbances
• Reduced adaptability to post partum status
• Depression (PP Depression) 1-2
1. Heaman, M. Stressful life events, social support, and mood
disturbance in hospitalized and non-hospitalized women with
pregnancy-induced hypertension. Canadian Journal of Nursing
Research. 2006, 24(1), 23-37.
2. Maloni, J.A., Brezinski-Tomasi, J.E., & Johnson, L.A. Antepartum
bed rest: Effect upon the family. JOGNN, 2011, 30(2), 165-173.

33. Roy’s Adaptation Model*
• Adjustment to motherhood is already a huge
transition and a great challenge
• Women with a high risk pregnancy will become
physically deconditioned from bed rest
* Roy, C.L. The Roy adaptation model. 2013.
bc.edu/school/son/faculty/featured/theorist/Roy_Adaptation_Model.html

34. Financial Factors
• Burden to family
members
• Third Party Payers

35. Why still so popular among
Obstetricians?
• As many as 95% of obstetricians report
recommending activity restriction or bed rest, in
some form, in their practices*
*“Therapeutic” Bed Rest in Pregnancy- Unethical
and Unsupported by Data. McCall CA, Grimes DA,
Lyerly AD Obstet Gynecol 2013;121:1305–8

36. • “we really don’t have
anything to offer you”
• “I’m sorry ma’am, there is
nothing we can do”
• “We are advising complete
bed rest”
• “Well, there’s no evidence
bed rest helps, but it is
something we can try”

37. Inherently Soothing and therapeutic
words
•Bed
•Rest

38. Bed????

39. Rest????

40. “Rest” in our body

41. • Antepartum bed-rest treatment should be
discontinued until evidence of effectiveness is
found.

42. One Minute Silence !!!!!
Bed Rest