Case Western Reserve University, Frances Payne BoltonSchool of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
Biol Res Nurs. 2010 Oct;12(2):106-24. doi: 10.1177/1099800410375978.
Preterm birth is the major maternal-child health issue across developed nations and the leading cause of perinatal mortality and morbidity. Of all deaths of infants <1 year of age in the United States in 2005, 68.6% occurred in infants born prior to term. Although the preterm birth rate in European countries is 5-7%, the U.S. preterm birth rate is 12.7%, representing an increase of 9% since 2000. Antepartum bed rest/activity restriction (ABR/AR) has been a mainstay of treatment to prevent preterm birth for the past 30 years prescribed for nearly 1 million women in the United States annually, despite a lack of evidence for its effectiveness. In fact, there is increasing evidence that ABR causes several adverse physiologic and psychological side effects among women and their infants. Unfortunately, these findings have had little impact on clinical practice. This integrative review of literature provides a comprehensive analysis of the evidence for the practice of prescribing ABR and its physiologic, behavioral, and experiential side effects. It also presents a model to guide continuing research about the effects of maternal bed rest as well as evidence supporting the use of home care with bed rest, a different, safe, and feasible model of prenatal care for treating women with pregnancy complications used particularly in other countries. Finally, suggestions to improve the health of high-risk pregnant and postpartum women and their infants are provided.
早产是发达国家主要的母婴健康问题，也是围产期死亡和发病的主要原因。2005 年在美国所有 1 岁以下婴儿死亡中，68.6%发生在早产儿中。尽管欧洲国家的早产率为 5-7%，但美国的早产率为 12.7%，自 2000 年以来增加了 9%。产前卧床休息/活动限制（ABR/AR）是过去 30 年来预防早产的主要治疗方法，尽管没有证据表明其有效，但每年仍有近 100 万美国妇女接受这种治疗。事实上，越来越多的证据表明 ABR 会给妇女及其婴儿带来一些不良的生理和心理副作用。不幸的是，这些发现对临床实践几乎没有影响。本文对文献进行了综合回顾，全面分析了规定 ABR 及其生理、行为和经验副作用的实践的证据。它还提出了一个模型，以指导关于母亲卧床休息效果的持续研究，以及支持使用家庭卧床休息护理的证据，这是一种不同的、安全的和可行的产前护理模式，用于治疗有妊娠并发症的妇女，特别是在其他国家使用。最后，提出了一些建议，以改善高危孕妇和产后妇女及其婴儿的健康。
