Bed rest with or without hospitalisation for hypertension during pregnancy

Shireen Meher; Edgardo Abalos; Guillermo Carroli

doi:10.1002/14651858.CD003514.pub2

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Analysis 1.1

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 1 Severe hypertension.

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Analysis 1.2

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 2 Severe pre‐eclampsia.

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Analysis 1.3

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 3 Eclampsia.

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Analysis 1.4

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 4 Elective delivery including elective caesarean section or induction of labour, or both.

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Analysis 1.5

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 5 Placental abruption.

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Analysis 1.6

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 6 Death of baby, including miscarriage, stillbirth, perinatal death, and neonatal death.

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Analysis 1.7

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 7 Death of baby by timing of death.

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Analysis 1.8

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 8 Preterm birth.

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Analysis 1.9

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 9 Endotracheal intubation.

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Analysis 1.10

Comparison 1 Strict bed rest in hospital versus some rest in hospital, Outcome 10 Admission to neonatal intensive care nursery.

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Analysis 2.1

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 1 Severe hypertension.

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Analysis 2.2

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 2 Pre‐eclampsia.

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Analysis 2.3

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 3 Elective delivery, including elective caesarean section or induction of labour, or both.

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Analysis 2.4

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 4 Caesarean section.

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Analysis 2.5

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 5 Death of baby.

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Analysis 2.6

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 6 Death of baby by timing of death.

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Analysis 2.7

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 7 Small‐for‐gestational age.

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Analysis 2.8

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 8 Preterm birth.

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Analysis 2.9

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 9 Preterm birth (subgroup by gestational age).

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Analysis 2.10

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 10 Admission to neonatal intensive care unit.

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Analysis 2.11

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 11 Women satisfied with management.

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Analysis 2.12

Comparison 2 Some rest in hospital versus routine activity at home, Outcome 12 Women not choosing same management for future pregnancy.

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Comparison 1. Strict bed rest in hospital versus some rest in hospital

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severe hypertension Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.93, 1.49]

2 Severe pre‐eclampsia Show forest plot	2	145	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [0.98, 2.30]

3 Eclampsia Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.85]

4 Elective delivery including elective caesarean section or induction of labour, or both Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.87, 1.34]

5 Placental abruption Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	4.91 [0.24, 99.82]

6 Death of baby, including miscarriage, stillbirth, perinatal death, and neonatal death Show forest plot	2	145	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.52, 2.19]

7 Death of baby by timing of death Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7.1 Stillbirth	2	145	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.45, 2.75]
7.2 Perinatal death	2	145	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.52, 2.19]
7.3 Neonatal death	2	145	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.28, 3.50]
8 Preterm birth Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.71, 1.35]

9 Endotracheal intubation Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.11, 3.76]

10 Admission to neonatal intensive care nursery Show forest plot	1	105	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.49, 1.17]

Comparison 1. Strict bed rest in hospital versus some rest in hospital

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Comparison 2. Some rest in hospital versus routine activity at home

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Severe hypertension Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.38, 0.89]

2 Pre‐eclampsia Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.80, 1.20]

3 Elective delivery, including elective caesarean section or induction of labour, or both Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.70, 1.37]

4 Caesarean section Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [0.79, 2.52]

5 Death of baby Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	1.96 [0.18, 21.34]

6 Death of baby by timing of death Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Stillbirth	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	4.91 [0.24, 101.10]
6.2 Perinatal death	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	1.96 [0.18, 21.34]
6.3 Neonatal death	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.95]
7 Small‐for‐gestational age Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.51, 1.91]

8 Preterm birth Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.29, 0.99]

9 Preterm birth (subgroup by gestational age) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

9.1 Birth < 37 weeks	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.29, 0.99]
9.2 Birth < 34 weeks	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.49 [0.09, 2.62]
10 Admission to neonatal intensive care unit Show forest plot	1	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.37, 1.81]

11 Women satisfied with management Show forest plot	1	86	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.92, 1.04]

12 Women not choosing same management for future pregnancy Show forest plot	1	86	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [1.43, 6.31]

Comparison 2. Some rest in hospital versus routine activity at home

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