“Therapeutic” Bed Rest in Pregnancy
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Abstract:
"Therapeutic" bed rest continues to be used widely, despite evidence of no benefit and known harms. In this commentary, we summarize the Cochrane reviews of bed rest and propose an ethical argument for discontinuing this practice. Cochrane systematic reviews do not support "therapeutic" bed rest for threatened abortion, hypertension, preeclampsia, preterm birth, multiple gestations, or impaired fetal growth. This assessment has been echoed in other comprehensive reviews. Prescribing bed rest is inconsistent with the ethical principles of autonomy, beneficence, and justice. Hence, if bed rest is to be used, it should be only within a formal clinical trial.Keywords:
Rest (music)
Therapeutic abortion
"Therapeutic" bed rest continues to be used widely, despite evidence of no benefit and known harms. In this commentary, we summarize the Cochrane reviews of bed rest and propose an ethical argument for discontinuing this practice. Cochrane systematic reviews do not support "therapeutic" bed rest for threatened abortion, hypertension, preeclampsia, preterm birth, multiple gestations, or impaired fetal growth. This assessment has been echoed in other comprehensive reviews. Prescribing bed rest is inconsistent with the ethical principles of autonomy, beneficence, and justice. Hence, if bed rest is to be used, it should be only within a formal clinical trial.
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Therapeutic abortion
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Whilst the medical indications for therapeutic abortion and the legal limitations set vary enormously from one country to another there is in general an undoubted trend towards giving the pregnant woman herself a greater say in the decision. During the first year of the operation of the Abortion Act, 1967, in England some 72 pregnant women were referred to the author and his colleagues for a recommendation on abortion. A psychiatric examination and follow-up over a period of one year was made both in those cases where abortion was performed as well as in those cases who were refused therapeutic abortion. In this communication a comparison is made between the reactions and outcome in the two groups. A provisional conclusion is reached that no significant psychiatric disturbance could be attributed to the performance of the operation or on the other hand to refusal of the woman's request.Although abortion laws and medical indications for therapeutic abortion vary from country to country, the overall trend is toward liberlization of laws to allow the pregnant woman a voice in the decision. When the Abortion Act was passed in England in 1967, 72 pregnant women were referred to the author and his colleagues for a recommendation on abortion. Of these, 13 were rejected, 5 were unmarried. the criterion for acceptance was the woman's ability to withstand strain, state or absence of marriage, parity, spacing of previous pregnancies, and economic stability. 11 of the 13 rejected cases delivered healthy infants and were reconciled to their situation. None showed signs of mental disorder. 55 terminations were completed. 45 women were well, without self-reproach or psychiatric disorder. 10 showed some self-reproach but were mildly inconvenienced by their feelings. None of the 72 women suffered psychiatric disorder.
Therapeutic abortion
Abortion law
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Data from the Growth of Alberta Family Study were used to estimate the illegal abortion rate for the residents of Edmonton, Alberta and to assess the potential impact of eliminating therapeutic abortion on the birth rate and on the illegal abortion rate. The study population consisted of 938 women, aged 18-54. The women were divided into 3 groups, and sensitive abortion data was elicited from each group using different data collection techniques. One group was asked about abortion in the traditional interview mode. Another group was asked to mail in their responses to abortion answers anonymously, and the remaining group was questioned about abortion using the (RRT) randomized response technique. The use of the RRT allowed the respondent to answer yes or no questions without the interviewer being aware that the respondent was responding to sensitive abortion questions. The RRT elicited information on a greater number of abortions than the other 2 techniques. According to calculations based on the RRT elicited information, the illegal abortion rate in Edmonton was 22.4/100 conceptions surviving the 1st 4 weeks of gestation. In view of the controversy surrounding the current abortion law, an effort was made to assess the effects of eliminating therapeutic abortions. A method, previously developed by Tietze for calculating the impact of abortion laws on the birth rate in New York, was applied to the Alberta data. The conclusion was reached that if therapeutic abortions were eliminated, the effect on the birth rate would be negligible and the illegal abortion rate would increase by 12%. The estimated illegal abortion rates and other major study results were presented in tabular form.
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Induced Abortions
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The paper on the role of rest in the treatment of infectious hepatitis by Repsher and Freebern in this week's Journal confirms the conclusions of a previous study among military personnel,1 except that in comparing ad-lib rest with vigorous daily exercise, it starts where the earlier study left off. During the Korean conflict patients on strict bed rest were found to improve no faster than those allowed ad-lib rest. Because the latter treatment was so contrary to the current beliefs of experts in liver disease, the investigators hedged by requiring the experimental group to stay on the hospital ward and . . .
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The experience of Denver General Hospital with Colorado's liberalized abortion law from May 1967 to July 1970 is used to indicate nationwide trends. 457 of 699 cases evaluated were approved for abortion. 70% of the applicants had family incomes below $6000 per year, indicating a trend of more awareness of the availability of abortion among poorer women. At all ages, the Therapeutic Abortion Board approved more applications than it rejected, most markedly in the 12-25 year groups. Special in-service training for staff along with extra psychiatric counseling and a psychiatric nurse were required to help accomodate the staff to the presence of abortion patients on the maternity floors. During the first year of the law, the eightfold increase in abortions in Colorado was confined to the Denver area. Only 3 or 4 hospitals outside Denver even performed abortions. However, more hospitals are becoming active, with both medical practitioners and hospitals becoming more accustomed to therapeutic abortion practice and taking a more relaxed attitude toward it. Abortion is still an emotional issue, but reform and change are inevitable.
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The effect of treatment with bed rest only and bed rest combined with ACTH was studied retrospectively in 55 multiple sclerosis (MS) patients suffering from 99 relapses. No convincing arguments in favour of the combination with ATCH over bed rest alone were found. A review of the literature on the treatment of exacerbations in multiple sclerosis patients with bed rest and ATCH is given.
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Abstract A total of 146 twin pregnancies were studied to evaluate the importance of bed rest. A significantly reduced frequency of preterm delivery was found after bed rest in hospital as compared to bed rest at home or no bed rest at all. An increase in gestational age and in birth weight was seen after bed rest. No effect was found on the intrauterine increase of fetal weight per time. Early routine ultrasound is recommended, so that effective bed rest may be instituted in due time.
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Twin Pregnancy
Fetal weight
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