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Activity restriction in pregnancy

The practice of activity restriction is a commonly used therapy in the context of many pregnancy morbidities. Currently available data does not show improvement in maternal or neonatal outcomes with the use of activity restriction, but does show an increase in maternal morbidities. 

Diagnosis/definition: The terms “bed rest” and “activity restriction” are often used synonymously, but can differ to a great extent in clinical practice. Most antepartum inpatients undergo “bed rest” as defined by Fox et al, that is, limited ambulation of not more than 1 to 2 hours per day with bathroom use and bathing permitted. In general, the term “activity restriction” is preferable to “bed rest.”

Epidemiology/Incidence: Survey data from several studies indicate that the prescription of activity restriction is a common practice among both obstetrician-gynecologists and maternal- fetal medicine subspecialists, despite the fact that many obstetric providers surveyed did not expect the practice to prevent adverse outcomes.

Risk factors/associations: Risk factors for being placed on activity restriction include preterm contractions, arrested preterm labor, short cervix, preterm premature rupture of membranes (PPROM), elevated blood pressure, preeclampsia, intrauterine growth restriction (IUGR), placenta previa, threatened abortion, and multiple gestation.

Complications: Lack of weightbearing activity results in loss of muscle mass, bone mass, plasma volume, and cardiovascular capacity. Pregnant women are known to be at increased risk of DVT and other thrombotic morbidities such as pulmonary embolism (PE), The data demonstrate an increased risk of thromboembolic events in patients placed on activity restriction.

Prevention: We recommend against the routine use of activity restriction or bed rest during pregnancy for any indication.