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Bed rest first trimester2/28/2024 Two trials that evaluated bed rest in pregnant women with vaginal bleeding in the first trimester have been identified and met the selection criteria. It was planned in the case of significant heterogeneity among study outcomes, that a sensitivity analysis would be performed, this was not required. ![]() We evaluated statistical heterogeneity across trials results using the Chi² test as calculated in MetaView. Studies were included irrespective of their methodological quality. The results are expressed as risk ratios and their 95% confidence intervals for dichotomous outcomes and mean difference with 95% confidence intervals for continuous outcomes, using the Cochrane Review Manager software ( RevMan 2000). The authors independently extracted data using a previously prepared data extraction form. For blinding of outcome assessment: (a) single, (b) no blinding or blinding not mentioned. For completeness of follow up: (a) less than 3% of participants excluded, (b) 3% to 9.9% of participants excluded, (c) 10% to 19.9% of participants excluded, (d) 20% or more of participants excluded. We used the methods described in the Cochrane Reviewers' Handbook ( Clarke 2000).Īllocation concealment: (a) adequate concealment (b) uncertain (c) inadequate concealment.īlinding and completeness of follow up were assessed for each outcome using the following criteria. Any disagreements were resolved by consensus or, if necessary, by a third author. Two authors independently assessed the inclusion criteria and methodological quality. Since the effectiveness of some other interventions to prevent miscarriage have been assessed in other systematic reviews ( Bamigboye 2003 Drakeley 2003 Haas 2008 Scott 1996) it is important to assess the effectiveness of bed rest to prevent miscarriage by reviewing the evidence from randomized controlled trials. It may also increase the time to completion of the miscarriage in inevitable losses, and affect maternal psychological adjustment. In addition, bed rest may increase the likelihood of thromboembolic events ( Kovacevich 2000), muscle atrophy and symptoms of musculoskeletal and cardiovascular deconditioning ( Maloni 1993 Maloni 2002), may be stressful and costly for women and their family ( Crowther 1995 Gupton 1997 Maloni 20), may induce self blame feelings in case of failure to comply with the prescription ( Schroeder 1996) and may increase costs for the health services ( Allen 1999 Goldenberg 1994 Schroeder 1996). The prescription of bed rest is probably futile in half of the cases of threatened abortion unless cardiac activity has been confirmed. ![]() Vaginal bleeding before 23 weeks occurs in 25% of pregnancies ( Stabile 1987), and once hemorrhage occurs, about half of the fetuses have no detectable cardiac activity ( Everett 1987 Goldenberg 1994). Therefore, it seems unlikely that bed rest could play a significant role in the reduction of spontaneous miscarriage. However, this hypothesis is limited by the fact that most of the causes of miscarriage are not related to physical activity. ![]() It is prescribed based on the idea that as hard work and hard physical activity during pregnancy are associated with miscarriage, bed rest might reduce the risk ( Lapple 1990). None of them have been proven to be effective ( Clifford 1996 Goldstein 1989 Porter 2006).īed rest is probably the most commonly prescribed intervention for preventing miscarriage ( Cunningham 1993 Schwarcz 1995), being mainly indicated in cases of threatened miscarriage (vaginal bleeding before 23 weeks of gestational age) but also in cases of a previous history of miscarriage ( Goldenberg 1994). Administration of hormones and immunotherapy are some of the examples. Many interventions have been used for preventing miscarriage, depending on the disorder thought to be the etiological factor. It is associated with chromosomal defects in about a half or two‐thirds of cases ( Bricker 2000 Ogasawara 2000 Simpson 1987 Stern 1996), with maternal diseases (endocrinological, immunological, malformations of the genital tract, infections), or placental dysfunction ( Cunningham 1993 Glass 1994). Miscarriage is pregnancy loss before 23 weeks of gestational age ( WHO 1992) and it happens in 10% to 15% of pregnancies depending on maternal age and parity ( Buckett 1997 Bulletti 1996 Schwarcz 1995).
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