Bed Rest for Hypertension in Pregnancy Not Backed

The Preeclampsia Foundation does not necessarily endorse any research or news found in this forum, we just want to share what is out there. Please use your own discretion to evaluate any information you find here.
two_tzu
Registered User
Posts: 33
Joined: Sun Aug 13, 2006 05:19 pm

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby two_tzu » Thu Sep 07, 2006 03:14 am

Catherine, You said it so well..."... for those of us who wonder if a problem had been recognized earlier, whether we might have had a smoother ride or a better outcome. The way that I interpret this is that, on the whole, not. Less guilt for me, and maybe others like me. That's not to say that there may not be benefits to bedrest. I wonder if for those who did stick it out, if there weren't the additional, accumulated and possibly unrecognized benefits of closer monitoring, greater use of meds, supervision of more experienced or expert doctors etc."

I am exactly in that spot right now, and the more I find out about PreE, I am realizing that nothing really could have gone differently with my pregnancy. I never developed the outward symptoms (proteinuria, swelling, etc) that my OB and I were looking out for before prescribing bedrest, and my PreE and HELLP symptoms developed so rapidly (over three days) that bedrest wouldn't have helped much.

Thank you all for such a great discussion.

lorelei
Registered User
Posts: 3788
Joined: Tue Oct 26, 2004 10:17 am

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby lorelei » Sat Oct 29, 2005 07:27 am

LOL Anne!

User avatar
annegarrett
Registered User
Posts: 2525
Joined: Tue Jan 21, 2003 01:58 pm
Location: Lake Stevens, Washington
Contact:

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby annegarrett » Fri Oct 28, 2005 11:10 pm

You all are probably as well informed if not more than most doctors out there, KWIM?!;) Love to talk about this stuff with knowledgeable women. I just throw that "not a doctor" thing in in case a lawyer is looking at my posts and thinking---that PF woman is advising no bedrest! I am not...(cause neither a doctor nor lawyer am I) advising anything. How's that for thoroughly unhelpful. :)

User avatar
caryn
Forum Moderator
Posts: 10178
Joined: Fri Jun 25, 2004 06:36 am

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby caryn » Wed Oct 26, 2005 00:25 am

I can't imagine anyone thinking I'm a medical doctor. Now Catherine, on the other hand...



User avatar
annegarrett
Registered User
Posts: 2525
Joined: Tue Jan 21, 2003 01:58 pm
Location: Lake Stevens, Washington
Contact:

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby annegarrett » Tue Oct 25, 2005 08:29 pm

It is good to see debate on this issue and in the interest of full disclosure: I was on bedrest in two pregnancies. Our Medical Board MOSTLY says that the science does not support bedrest. Science is a tricky thing--if you look hard enough you can get pretty confused by what it does and does not support but SO FAR the evidence on the value of bedrest is pretty lukewarm. It is so popular because this is a disease where the doctors have not much to offer and it is at least something. The bottom line is as Laura said the PF has no stance on the value of bedrest--that is between you and your doctor and more importantly, no one should feel that whether or not they did or did not do bedrest and how "well they did bedrest" impacted their outcome. The last thing we want is for women who have had a loss or traumatic birth to add the feeling of guilt to that. Bedrest is no picnic and if you are like I was--it is pretty hard to do well with little ones in school and a working spouse. I imagine it does help some of us and for others it doesn't. The bottom line is that preeclampsia is a snowball that starts at the placenta. So far there is no good science supporting bedrest but trust me--if I found myself pregnant again (just kill me now)--I would likely go on modified bedrest. My two cents.

Thanks Laura for making our stance clear. We have a moral obligation to the women we serve here to be very clear that we are not doctors and our individual outcomes are just that--our own.

Thanks to everyone for a lively debate.

Take care!!

akemt
Registered User
Posts: 4961
Joined: Sun Feb 09, 2003 07:35 pm

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby akemt » Sun Oct 23, 2005 11:00 pm

You know, I think we all agree -atleast for the most part. We know what the experts say, but it is when we add our personal experiences that our opinions begin to differ. That is understandable!

Really, we cannot argue whether someone's opinion is right or wrong - that is the nature of opinions. Medical science works from the basis of seeking for truth by what we observe in strict settings. Opinions can be based on medical science or go directly against it and even medical science has inaccuracies. In my opinion (ha ha), the two aren't comparable.

lorelei
Registered User
Posts: 3788
Joined: Tue Oct 26, 2004 10:17 am

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby lorelei » Sat Oct 22, 2005 12:45 am

I am w/you on the recovery part Laura. I spent 13 weeks on bedrest w/Hunter, and while I know in my situation it helped me bc as soon as I hit my feet bp shot up but as soon as I was down it was good, it took a long time physically, emotionally for me to get back to normal. I was so weak physically from not doing ANYTHING that I was very winded and my legs felt like jelly. Also mentally it was a hard place to be, and a hard place to go back to to this day. I agree w/you. In my opinion, and this is really OT I know, I think of bedrest working for people like a cancer drug. You take two people diagnosed w/the same type of cancer, same staging, what have you. Give them the same medication, etc one is going to respond and go into remission, the other as we know could have a very different outcome. I think bedrest is the same way..there are some that it is going to help and some that won't respond to it. If you think about it for most of us that did the bedrest there came a point when the bedrest stopped helping. I know for me that time came around week 36 in both of my pregnancies.

Interesting subject..

laura
Registered User
Posts: 5139
Joined: Tue Jan 28, 2003 12:17 am
Location: Anchorage, AK

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby laura » Sat Oct 22, 2005 11:21 am

quote:
Originally posted by Caryn


This might well support the claim that positive responses to bedrest are very rare, and that it is not beneficial in broad populations. Bedrest can have very negative consequences, like bone demineralization and pulmonary embolisms, and the likelihood of harm has to be weighed here as well.



And that's what I hear when I hear the docs talk about the pros and cons of bedrest- it could theoretically help, it hasn't shown to- but muscle weakness, blood clots-- and to me personally a big concern--- antepartum and postpartum depression makes it of questionable value.

I did bedrest. To the extreme. I had hyperemesis for the first 20 weeks, bedrest from low fluid from 24 weeks onward. I was in bed for a year, for all intents and purposes, and it took me 18 months to recover physically. I will probably never have another child because the prospect of being in bed for a year is just too much.

I say- if it works for you- do it-- but I do not want anyone who wasn't able to do bedrest or didn't strictly adhere to bedrest to think or feel guilty if they had any type of negative outcome because as we're saying here, the studies that looked specifically at bedrest have not shown them to prolong pregnancies.

User avatar
caryn
Forum Moderator
Posts: 10178
Joined: Fri Jun 25, 2004 06:36 am

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby caryn » Sat Oct 22, 2005 03:44 am

(Not sure how to do the quote thing, but I'll fall back on Usenet standards... BTW Deerhart, I like to argue too. :-) )

Deerhart said:

> And there are many benefits to having your BP lowered, both to
> the mother

Absolutely.

> and the baby.

Debatable. If you check the official working group report (the URL is a sticky at the top of the research forum), it says this about using drugs to lower bp (emphasis mine):

"The value of continued administration of antihypertensive drugs to pregnant women with chronic hypertension continues to be an area of debate. Although it may be beneficial for the mother with hypertension to reduce her blood pressure, lower pressure may impair uteroplacental perfusion and thereby jeopardize fetal development (Type of Evidence: M)."

Lowering pressures with bedrest might well be subject to the same criticism.

In addition, our current best guess at the preeclampsia factor, sflt-1, may be upregulated in response to hypoxia, which might suggest that anything compromising blood flow to the placenta might make things worse in at least some cases.

> I will completely argue with you that dropping the BP doesn't
> delay delivery, becuase it does.

The study says:

"a borderline reduction of risk of preterm delivery"

This means that it may not actually pan out in further studies, because the data is almost not rising to the level of statistical significance -- if they're using standard methodology, there's about a 1:20 chance that this result was purely random.

It also says, "Other outcomes were comparable for both groups." This might mean that the two groups had comparable pregnancy lengths plus or minus a day; I don't know. (I haven't accessed the full text of the study yet...)

Although we have plenty of anecdotes suggesting that bedrest does delay delivery, we don't have the science to support it. We only have our personal anecdotes, which aren't scientific data. As they say, "The plural of anecdote is not data."

> An emperical study could be done, but it would probably be very
> complicated and I am not sure researchers are yet ready to focus
> on something like this yet. It would be far easier once they can
> start to more accurately predict who will get PE and what is
> causing it.

Absolutely. The new urine and blood tests currently in development should help a lot in narrowing down a study population.

>(the nurse I had in my 2nd labor flat out stated she had never seen
> anyone's BP react to positional changes as it did in me in her 20
> years of nursing)

This might well support the claim that positive responses to bedrest are very rare, and that it is not beneficial in broad populations. Bedrest can have very negative consequences, like bone demineralization and pulmonary embolisms, and the likelihood of harm has to be weighed here as well.

I'm not trying to make any claims that bedrest wasn't causally effective for you personally. I'm just saying that we don't have good evidence that it is broadly applicable. We don't know why it worked for you, or if it was just luck both times for that matter, and that means we can't generalize from your experience (or mine) to other people.

missgamecock
Registered User
Posts: 6064
Joined: Fri May 30, 2003 06:34 pm

Re : Bed Rest for Hypertension in Pregnancy Not Backed

Postby missgamecock » Fri Oct 21, 2005 05:20 pm

Erin agree with you on delaying the delivery. Had I have not have been on bedrest that last month, I would have delivered probably around 32 weeks this time. My ob and the midwife and the peri (cause I saw all three in the last month that I was pregnant) would say go home and go to bed and don't move. That is the only way you are going to be able to deliver in town. That is what I did. I see my ob and he be like well everything is still ok go home and go to bed. I totally will be going out on bedrest as soon as I need to next time. In fact I am going to pay for a private disability insurance plan specifically for this. My bp was still high while laying down but it wasn't nearly as high as it was sitting. Some people it doesn't work. Some people it does. I know it worked for me. I also know that when I was in labor with Sara, I was kept on my left side, which did not make me a happy camper. Cause the tv was in front of my bed more to the right. I was only allowed to change to the right side once I was given the epidural and it didn't work. The midwife said that sometimes switching evens it out. Nope not for me. I was only 2 hours away from delivering at that point.


Return to “Announcements and Preeclampsia in the News”

Who is online

Users browsing this forum: No registered users and 2 guests