American College of Obstetricians and Gynecologists

View all recommendations from this society

Released March 14, 2016

Don’t routinely recommend activity restriction or bed rest during pregnancy for any indication.

Bed rest or activity restriction has been commonly recommended for a variety of conditions in pregnancy including multiple gestation, intrauterine growth restriction, preterm labor, premature rupture of membranes, vaginal bleeding and hypertensive disorders in pregnancy. However, information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction, but does show an increase in loss of muscle conditioning and thromboembolic disease.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

As a national medical specialty society, the American College of Obstetricians and Gynecologists relies on the input of any number of its committees in the development of various documents. In the case of the items submitted for the Choosing Wisely® campaign, input from the following committees was solicited: the Committees on Patient Safety and Quality Improvement; Obstetric Practice; and Gynecologic Practice. A literature search was conducted related to the initial list of approximately ten items. We then sent this list to the College’s Executive Board and asked them to select five of the items based on their potential to improve quality and reduce cost. We explained to them that the items were written to avoid complex or clinical terminology, but not at the risk of reducing the value and credibility of the recommendations made. In the case of the first two items on our list – “Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age” and “Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable” – we collaborated with the American Academy of Family Physicians in developing the final language. A list of the second set of “five items” was selected by the Committee on Patient Safety and Quality Improvement before submission to the College’s Executive Board for approval. Any comments received from the Executive Board were incorporated into the final list that was approved.

The College’s disclosure and conflict of interest policy can be found at www.acog.org.

Sources

McCall CA, Grimes DA, Lyerly AD. “Therapeutic” bed rest in pregnancy: unethical and unsupported by data. Obstet Gynecol. 2013;121:1305–8.

Fox NS, Gelber SE, Kalish RB, Chasen ST. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. Am J Obstet Gynecol. 2009;200:165.e1–165.e6.

Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Obstet Gynecol. 2013;121:1181–6.

Maloni JA. Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstet Gynecol. 2011;6:385–93.

Brennan MC, Moore LE. Pulmonary embolism and amniotic fluid embolism in pregnancy. Obstet Gynecol Clin North Am. 2013;40:27–35.

Promislow JH, Hertz-Picciotto I, Schramm M, Watt-Morse M, Anderson JJ. Bed rest and other determinants of bone loss during pregnancy. Am J Obstet Gynecol. 2004;191:1077–83.

Merriam AA, Chichester M, Patel N, Hoffman MK. Bed rest and gestational diabetes: more reasons to get out of bed in the morning [abstract]. Obstet Gynecol. 2014;123(suppl 1):70S.

Sosa CG, Althabe F, Belizán JM, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD003581.

Sciscione AC. Maternal activity restriction and the prevention of preterm birth. Am J Obstet Gynecol. 2010;202:232.e1–e5.