Hospitalisation and bed rest for multiple pregnancy

 

Abstract

Background

Bed rest used to be widely advised for women with a multiple pregnancy.

Objectives

The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2010).

Selection criteria

Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred.

Data collection and analysis

The review authors carried out assessment for inclusion and risk of bias of the trials. We extracted and double entered data, and used a random-effects model.

Main results

We included seven trials which involved 713 women and 1452 babies. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was substantial heterogeneity related to perinatal death and stillbirth unaccounted for by trial quality. There was a suggestion of a decreased number of low birthweight infants (less than 2500 g) born to women in the routinely hospitalised group (risk ratio (RR) 0.92; 95% confidence interval (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 is 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.

Authors' conclusions

There is currently not enough evidence to support a policy of routine hospitalisation for bed rest in multiple pregnancy. No reduction in the risk of preterm birth or perinatal death is evident, although there is a suggestion that fetal growth may be improved. For women with an uncomplicated twin pregnancy the results of this review show no benefit from routine hospitalisation for bed rest. Until further evidence is available, the policy cannot be recommended for routine clinical practice.

 

Plain language summary

Hospitalisation and bed rest for multiple pregnancy

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.

 

摘要

背景

多胞胎妊娠之住院與臥床休息

一般會建議多胞胎妊娠孕婦臥床休息

目標

評估住院臥床休息對於多胞胎妊娠孕婦預防早產、其他有關胎兒、新生兒與母親結果的效果

搜尋策略

搜尋Cochrane Pregnancy and Childbirth Group trials register、以及Cochrane Controlled Trials Register和相關報告的參考文獻。最後搜尋日期：2000年8月

選擇標準

隨機抽樣控制試驗比較多胞胎妊娠孕婦，提供住院臥床和發生併發症後才臥床對孕婦和其胎兒的結果

資料收集與分析

由回顧者評估試驗之納入與方法品質，及摘錄資料並覆核輸入。所有適用的試驗都納入進行初步分析。進行預先定義的敏感度分析以評估試驗品質、無併發症雙胞胎孕婦住院臥床休息的效果、三胞胎孕婦以及有產前子宮頸管消失(cervical effacement)和子宮口擴張(dilatation)併發症之雙胞胎孕婦住院臥床休息的效果

主要結論

納入6篇試驗、超過600名婦女以及1400名嬰兒。(1)分析所有試驗。多胞胎妊娠例行性在醫院臥床休息並未減少早產或周產期死亡率風險。例行性住院組的低出生體重嬰兒數有減少趨勢，如果排除交互分派型的試驗之後，此結果變為顯著(OR為0.79 5% CI為0.63 – 0.99)。極低出生體重嬰兒數方面沒有差異。其他新生兒結果沒有發現可供支持的證據。在任何試驗中，皆無嬰兒發育結果的資料。很少有關於婦女對所接受之照護的觀感的報告。(2)分析無併發症雙胞胎孕婦的住院臥床休息，並沒有減少早產風險(未減少)。甚至有較多婦女極早產(very preterm)(妊娠小於34週)(OR為1.84 5% CI為1.01 – 3.34)。周產期死亡率或其他新生兒結果顯示沒有差異。住院臥床休息孕婦發生高血壓的風險降低(OR為0.55; 95% CI為0.32 – 0.97)，不過，排除交互分派型的試驗之後，此結果不再明顯。(3)分析三胞胎孕婦臥床休息(住院組和控制組的比較)多數認為例行性住院臥床休息有助於治療，不過，兩組之間觀察到的所有差異相當於機會變異(chance variation)。(4)分析產前子宮頸管削除和子宮口擴張併發症之雙胞胎孕婦的住院臥床休息，早產風險、周產期死亡率、胎兒生長或其他新生兒結果都沒有顯示差異

作者結論

目前沒有足夠證據支持多胞胎妊娠例行性住院臥床休息的政策。早產風險或周產期死亡並未減少，不過，認為可改善胎兒生長。對於無併發症的雙胞胎孕婦，回顧結果認為，可能有傷害，因為更(極)早產的風險增加。除非有更多反對的證據，此政策不應被建議為例行性臨床實務

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

多胞胎妊娠之住院與臥床休息。 並無多胞胎妊娠孕婦住院臥床休息可減少早產風險的有力證據。多胞胎妊娠的早產風險較高，且胎兒在懷孕期間的發育比單胞胎不佳。一般廣為建議臥床休息以減少這些風險並改善胎兒生長。許多回顧試驗發現，例行性住院臥床休息並未減少早產風險，但是可改善胎兒生長。臥床對於無併發症的雙胞胎孕婦可能有傷害，因為可能會更(極)早產。住院臥床休息對於三胞胎孕婦似乎有好處，不過這些可能只是機會使然罷了