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Meta-Analysis
. 2010 Jul 7;2010(7):CD000110.
doi: 10.1002/14651858.CD000110.pub2.

Hospitalisation and bed rest for multiple pregnancy

Caroline A Crowther  1 , Shanshan Han
Affiliations
Meta-Analysis

Hospitalisation and bed rest for multiple pregnancy

Caroline A Crowther et al. Cochrane Database Syst Rev. .

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 strategy: 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.

PubMed Disclaimer

Conflict of interest statement

CA Crowther was chief investigator on four of the trials included in this review.

Figures

1.1
1.1. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 1 Perinatal death.
1.2
1.2. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 2 Stillbirth.
1.3
1.3. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 3 Early neonatal death.
1.4
1.4. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 4 Gestational age at delivery.
1.5
1.5. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
1.6
1.6. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
1.7
1.7. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 7 Birthweight twinI/triplet I.
1.8
1.8. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 8 Birthweight twinII/triplet II.
1.9
1.9. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 9 Low birthweight (< 2500 g).
1.10
1.10. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 10 Very low birthweight (< 1500 g).
1.11
1.11. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
1.12
1.12. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 12 Spontaneous onset of labour.
1.13
1.13. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 13 Caesarean delivery.
1.14
1.14. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
1.15
1.15. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
1.16
1.16. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 16 Admission to neonatal care unit.
1.17
1.17. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 17 Neonatal stay => 7 days.
1.18
1.18. Analysis
Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 18 Development of maternal hypertension.
2.1
2.1. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 1 Perinatal death.
2.2
2.2. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 2 Stillbirth.
2.3
2.3. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 3 Early neonatal death.
2.4
2.4. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 4 Gestational age at delivery.
2.5
2.5. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
2.6
2.6. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
2.7
2.7. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 7 Birthweight twin I/triplet I.
2.8
2.8. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 8 Birthweight twin II/triplet II.
2.9
2.9. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 9 Low birthweight (< 2500 g).
2.10
2.10. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 10 Very low birthweight (< 1500 g).
2.11
2.11. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
2.12
2.12. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 12 Spontaneous onset of labour.
2.13
2.13. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 13 Caesarean delivery.
2.14
2.14. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
2.15
2.15. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
2.16
2.16. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 16 Admission to neonatal care unit.
2.17
2.17. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 17 Neonatal stay => 7 days.
2.18
2.18. Analysis
Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 18 Development of maternal hypertension.
3.1
3.1. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 1 Perinatal death.
3.2
3.2. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 2 Stillbirth.
3.3
3.3. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 3 Early neonatal death.
3.4
3.4. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 4 Gestational age at delivery.
3.5
3.5. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
3.6
3.6. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
3.7
3.7. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 7 Birthweight triplet I.
3.8
3.8. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 8 Birthweight triplet II.
3.9
3.9. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 9 Birthweight triplet III.
3.10
3.10. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 10 Low birthweight (< 2500 g).
3.11
3.11. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 11 Very low birthweight (< 1500 g).
3.12
3.12. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 12 Prelabour preterm rupture of the membranes.
3.13
3.13. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 13 Spontaneous onset of labour.
3.14
3.14. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 14 Caesarean delivery.
3.15
3.15. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 15 Apgar score < 7 at 1 minute.
3.16
3.16. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 16 Apgar score < 7 at 5 minutes.
3.17
3.17. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 17 Admission to neonatal care unit.
3.18
3.18. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 18 Neonatal stay => 7 days.
3.19
3.19. Analysis
Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 19 Development of maternal hypertension.
4.1
4.1. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 1 Perinatal death.
4.2
4.2. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 2 Stillbirth.
4.3
4.3. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 3 Early neonatal death.
4.4
4.4. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 4 Gestational age at delivery.
4.5
4.5. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
4.6
4.6. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
4.7
4.7. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 7 Birthweight twin I.
4.8
4.8. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 8 Birthweight twin II.
4.9
4.9. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 9 Low birthweight (< 2500 g).
4.10
4.10. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 10 Very low birthweight (< 1500 g).
4.11
4.11. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
4.12
4.12. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 12 Spontaneous onset of labour.
4.13
4.13. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 13 Caesarean delivery.
4.14
4.14. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
4.15
4.15. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
4.16
4.16. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 16 Admission to neonatal care unit.
4.17
4.17. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 17 Neonatal stay => 7 days.
4.18
4.18. Analysis
Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 18 Development of maternal hypertension.
5.1
5.1. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 1 Perinatal death.
5.2
5.2. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 2 Stillbirth.
5.3
5.3. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 3 Early neonatal death.
5.4
5.4. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 4 Gestational age at delivery.
5.5
5.5. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 5 Preterm delivery (< 37 weeks).
5.6
5.6. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 6 Very preterm delivery (< 34 weeks).
5.7
5.7. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 7 Birthweight twin I/triplet I.
5.8
5.8. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 8 Birthweight twin II/triplet II.
5.9
5.9. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 9 Low birthweight (< 2500 g).
5.10
5.10. Analysis
Comparison 5 Quality (excluding trials with inadequate allocation concealment): treatment versus control, Outcome 10 Very low birthweight (< 1500 g).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Crowther 1989 {published data only}
    1. Crowther CA, Neilson JP, Verkuyl DAA, Bannerman C, Ashurst HM. Preterm labour in twin pregnancies: can it be prevented by hospital admission?. British Journal of Obstetrics and Gynaecology 1989;96:850‐3. - PubMed
Crowther 1990 {published data only}
    1. Crowther CA, Verkuyl DAA, Neilson JP, Bannerman C, Ashurst HM. The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy. British Journal of Obstetrics and Gynaecology 1990;97:872‐7. - PubMed
Crowther 1991 {published data only}
    1. Crowther CA, Verkuyl D, Ashworth M, Bannerman C, Ashurst H. The effects of hospitalisation for bed rest on duration of gestation, fetal growth and neonatal morbidity in triplet pregnancy. Acta Geneticae Medicae et Gemellologiae 1991;40:63‐8. - PubMed
Dodd 2005 {published data only}
    1. Dodd JM, Crowther CA. Hospitalisation for bed rest for women with a triplet pregnancy: an abandoned randomised controlled trial with meta‐analysis. BMC Pregnancy and Childbirth 2005;5:8. - PMC - PubMed
Hartikainen‐Sorri 1984 {published and unpublished data}
    1. Hartikainen‐Sorri AL, Jouppila P. Is routine hospitalization needed in antenatal care of twin pregnancy?. Journal of Perinatal Medicine 1984;12:31‐4. - PubMed
Maclennan 1990 {published data only}
    1. MacLennan AH, Green RC, O'Shea R, Brookes C, Morris D. Routine hospital admission in twin pregnancy between 26 and 30 weeks' gestation. Lancet 1990;335:267‐9. - PubMed
Saunders 1985 {published data only}
    1. Saunders MC, Dick JS, Brown I McL, McPherson K, Chalmers I. The effects of hospital admission for bed rest on the duration of twin pregnancy: a randomised trial. Lancet 1985;2:793‐5. - PubMed

References to studies excluded from this review

Gummerus 1985 {published data only}
    1. Gummerus M, Halonen O. Prophylactic long‐term oral tocolysis of multiple pregnancies. British Journal of Obstetrics and Gynaecology 1987;94(3):249‐51. - PubMed
    1. Gummerus M, Halonen O. The merits of betamimetic treatment and bed rest in multiple pregnancies [Vuodelevon ja beetasympatomimeetthoidon vaikutus monisikioisessa raskaudessa]. Duodecim 1985;101:1966‐71. - PubMed

References to studies awaiting assessment

al‐Najashi 1996 {published data only}
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References to other published versions of this review

Crowther 1991a
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Crowther 1991b
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Crowther 1991c
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Crowther 1991d
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Crowther 1995a
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Crowther 1995b
    1. Crowther CA. Hospitalisation for bed rest in triplet pregnancy. [revised 05 October 1993]. In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Crowther 1995c
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Crowther 1995d
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Crowther 1997
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