Bed rest in twin pregnancy: Identification of a critical period and its cost implications

Multiple Pregnancies

“…Early bed rest has been proposed to improve twin survival (Anonymous 1963b ) . The cost of this measure is formidable (Powers and Miller 1979 ) , however, and careful appraisal with random trials has shown that it is inef fi cacious. In fact, with early admission and bed rest, the prematurity rate is increased.…”

The Northwestern University Twin Study. VIII: On the Causes and Care of Multiple Pregnancy

“…What has become clear, however, is that maternal erect posture [77] increases the frequency of uterine contractions and that these contractions can be measured accurately on an ambulatory basis [57]. In addition, the importance of heavy physical exertion in causing premature labor has been clarified [83], and the social costs of preterm twin pregnancies have been amply documented [65,72,73,83]. Thus, while it seems reasonable to agree with Hartikainen-Sorri and Jouppila [24] that hospitalization per se may not be required in ali uncomplicated twin pregnancies, reduction of maternal activity appears warranted in almost every case [82], as is bed rest at home [39], home visits by members of the health care team [1,83], careful evaluation of the cervical state for effacement and dilatation [40,66], and the use of ambulatory uterine contraction monitoring devices where possible [57].…”

“…The common thread which unites these and other papers [18,60,64,67,74,80,82] is the issue of the perinatal mortality rate in twins, its causes [14,28] and the means for its reduction [25,39,69,82]. An additional concern, although not voiced as frequently, is the cost of providing neonatal care to large numbers of preterm newborns [4,65,72,73,82].…”

A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges: Part II—The 1990s, the New Millennium, Future Challenges

“…90 Importantly, "It relies on promotion of the skills and attitudes of good citizenship in medical education." 91 Most current maternal interventions, including enhanced prenatal care programs, nutritional support, home monitoring for early detection of labor, and bed rest, 92 have proved to be ineffective in preventing premature births. 93 Tocolytic agents are effective in the initial management of acute preterm labor and may provide time to use prenatal steroids.…”