Bed rest in singleton pregnancies for preventing preterm birth
RHL practical aspects by Qureshi Z
FIRST CONTACT (PRIMARY CARE) LEVEL
To help reduce the incidence of preterm birth, health-care practitioners at this level of care should first encourage women to seek antenatal care from skilled practitioners, preferably during the first trimester of pregnancy, as recommended by WHO (1). At the first antenatal care visit, appropriate measures should be taken to identify women who may require specialized care during their pregnancy: women who are found to be at risk of preterm labour should be referred to the next level of care.
Pregnant women and their relatives should be given information on the importance of good nutrition and avoidance of strenuous work for long periods of time during pregnancy. They should be counselled on the danger signs during pregnancy, including signs that indicate preterm labour. At the same time help should be provided to women to prepare an emergency plan for delivery. Women should also be encouraged to seek care early when the danger signs arise. Women should also be informed about ways to prevent malaria, anaemia and sexually transmitted infections, since these are the major contributing factors for preterm birth.
The health-care facility should have a mechanism in place to refer women rapidly to an appropriate health-care facility when a pregnant woman arrives with signs of preterm labour.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
All the above suggestions for the first level of care also apply to this level. In addition, women with a history of preterm births should receive appropriate care based on practices shown to be effective. Women with preterm labour should be treated intensively to prevent preterm birth and steroids should be administered to prevent neonatal morbidity and mortality (2). Facilities that admit women for the treatment of preterm labour should have appropriate neonatal care facilities.
Women who report several previous pregnancy losses (whether or not they confirmed to be due to cervical incompetence) and who arrive late for cervical cerclage may require hospitalization for bed rest.
AT HOME OR IN THE COMMUNITY
Women should be advised to avoid heavy strenuous work for long periods of time during pregnancy and to seek antenatal care early and present themselves at a health facility in case of appearance of danger signs.
Sources of support: None
Acknowledgement: Dr Kizito Lubano (MBChB, M.MED, MSc) Research Officer, Reproductive Health Research Unit, Kenya Medical Research Institute, Nairobi, Kenya.
- WHO antenatal care randomized trial: manual for the implementation of the new model. Geneva: World Health Organization, 2001. (Available in RHL. See Implementation aids.)
- Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004454. DOI: 10.1002/14651858.CD004454.pub2.
This document should be cited as: Qureshi Z. Bed rest in singleton pregnancies for preventing preterm birth: RHL practical aspects (last revised: 31 August 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.