Preeclampsia is a serious condition characterized by the new onset of high blood pressure and signs of damage to another organ system, typically the kidneys or liver, after 20 weeks of gestation. This life-threatening disorder affects between 2% and 8% of pregnancies globally, posing significant risks to both mother and baby. For decades, bed rest was a common prescription for managing this condition, but medical consensus has now shifted dramatically against this practice.
Understanding Preeclampsia
Preeclampsia is diagnosed when a pregnant person develops sustained blood pressure readings of 140/90 mmHg or higher on two separate occasions after the 20th week of pregnancy. Current diagnostic criteria include new-onset hypertension accompanied by low platelet count, impaired liver function, kidney problems, fluid in the lungs, or new visual or neurological symptoms. The condition is categorized as having “severe features” if blood pressure reaches 160/110 mmHg or higher, or if specific signs of organ dysfunction are present. Prompt diagnosis and monitoring are paramount because preeclampsia can rapidly progress, potentially leading to seizures, stroke, and organ failure.
The Historical Use of Bed Rest
The practice of prescribing bed rest for preeclampsia was widespread for many decades, rooted in a theoretical, unproven benefit. Physicians believed that lying down, particularly on the left side, would reduce maternal blood pressure by decreasing physical strain. It was also hypothesized that this position would increase blood flow to the placenta, which is often compromised in preeclampsia, thereby improving the baby’s growth. This rationale led to the common recommendation of strict home or hospital confinement, often for weeks or months, despite the lack of strong clinical evidence.
Current Evidence on Bed Rest Efficacy
Modern scientific investigation, primarily through randomized controlled trials, has demonstrated that bed rest does not improve outcomes for women with preeclampsia. Studies comparing bed rest to normal activity failed to show a reduction in severe preeclampsia, preterm birth, or other adverse perinatal results. Strict bed rest has not been shown to lower rates of stillbirth, neonatal mortality, or admission to the neonatal intensive care unit. The lack of benefit combined with significant risks has led major medical organizations to recommend against its routine use.
The negative consequences of prolonged inactivity are substantial, affecting physical and psychological well-being. Extended bed rest significantly increases the risk of developing deep vein thrombosis (DVT), a dangerous condition where blood clots form in the deep veins, which can lead to a pulmonary embolism. Physical side effects also include rapid muscle atrophy, loss of bone density, and decreased cardiovascular fitness. Psychologically, women frequently experience increased anxiety, depression, and stress due to isolation and the disruption of their family and work life.
Modern Strategies for Preeclampsia Management
The current approach to managing preeclampsia focuses on close maternal and fetal surveillance, blood pressure control, and timely delivery. Management involves frequent monitoring of blood pressure, blood tests to check liver and kidney function, and regular fetal assessments, such as non-stress tests and ultrasound evaluations. Antihypertensive medications, such as labetalol or nifedipine, are used to safely lower and stabilize high blood pressure, reducing the risk of maternal complications like stroke.
The only definitive cure for preeclampsia is the delivery of the baby and the placenta. The timing of delivery is carefully balanced between the severity of the mother’s condition and the baby’s gestational age. In cases without severe features, expectant management often continues until 37 weeks, allowing the baby more time to mature. For severe preeclampsia, delivery is generally recommended at or after 34 weeks, or sooner if the mother’s or baby’s health is in immediate danger, with magnesium sulfate given beforehand to prevent maternal seizures.