Hospitalisation and Bed Rest For Multiple Pregnancy (Review)

Hospitalisation and bed rest for multiple pregnancy (Review)
Crowther CA
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 3 http://www.thecochranelibrary.com
Hospitalisation and bed rest for multiple pregnancy (Review) Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.1. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 1 Perinatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.2. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 2 Stillbirth. Analysis 1.3. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 3 Early neonatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.4. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 4 Gestational age at delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.5. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 5 Preterm delivery (< 37 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.6. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 6 Very preterm delivery (< 34 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.7. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 7 Birthweight twinI/triplet I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.8. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 8 Birthweight twinII/triplet II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.9. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 9 Low birth weight (< 2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.10. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 10 Very low birth weight (< 1500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.11. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 11 Prelabour preterm rupture of the membranes. . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.12. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 12 Spontaneous onset of labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.13. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 13 Caesarean delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.14. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 14 Apgar score < 7 at 1 minute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.15. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 15 Apgar score < 7 at 5 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.16. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 16 Admission to neonatal care unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.17. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 17 Neonatal stay => 7days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 1.19. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 19 Development of maternal hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.1. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 1 Perinatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 1 2 2 3 3 4 5 5 5 6 7 13 16 17 18 19 20 20 21 22 22 23 24 24 25 25 26 27 27 28 28
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Analysis 2.2. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 2 Stillbirth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.3. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 3 Early neonatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.4. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 4 Gestational age at delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.5. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.6. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.7. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 7 Birthweight twinI/triplet I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.8. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 8 Birthweight twinII/triplet II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.9. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 9 Low birth weight (< 2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.10. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 10 Very low birth weight (< 1500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.11. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes. . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.12. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 12 Spontaneous onset of labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.13. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 13 Caesarean delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.14. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.15. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.16. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 16 Admission to neonatal care unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.17. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 17 Neonatal stay => 7days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 2.19. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 19 Development of maternal hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.1. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 1 Perinatal death. Analysis 3.2. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 2 Stillbirth. . Analysis 3.3. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 3 Early neonatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.4. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 4 Gestational age at delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.5. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 5 Preterm delivery (< 37 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.6. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 6 Very preterm delivery (< 34 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.7. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 7 Birthweight triplet I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.8. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 8 Birthweight triplet II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.9. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 9 Birthweight triplet III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.10. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 10 Low birth weight (< 2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29 30 30 31 31 32 32 33 33 34 34 35 35 36 36 37 37 38 38 39 39 40 40 41 41 42 42
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Analysis 3.11. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 11 Very low birth weight (< 1500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.12. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 12 Prelabour preterm rupture of the membranes. . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.13. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 13 Spontaneous onset of labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.14. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 14 Caesarean delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.15. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 15 Apgar score < 7 at 1 minute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.16. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 16 Apgar score < 7 at 5 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.17. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 17 Admission to neonatal care unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.18. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 18 Neonatal stay => 7days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 3.20. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 20 Development of maternal hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.1. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 1 Perinatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.2. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 2 Stillbirth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.3. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 3 Early neonatal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.4. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 4 Gestational age at delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.5. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.6. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks). . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.7. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 7 Birthweight twin I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.8. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 8 Birthweight twin II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.9. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 9 Low birth weight (< 2500g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.10. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 10 Very low birth weight (< 1500g). . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.11. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes. . . . . . . . . . . . . . . . . . . . . . . Analysis 4.12. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 12 Spontaneous onset of labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.13. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 13 Caesarean delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.14. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.15. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.16. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 16 Admission to neonatal care unit. . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis 4.17. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 17 Neonatal stay => 7days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43 43 44 44 45 45 46 46 47 47 48 48 49 49 50 50 51 51 52 52 53 53 54 54 55 55
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Analysis 4.19. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 19 Development of maternal hypertension. . . . . . . . . . . . . . . . . . . . . . . . 56 WHATS NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
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[Intervention Review]
Hospitalisation and bed rest for multiple pregnancy

Caroline A Crowther1
1 ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia
Contact address: Caroline A Crowther, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Womens and Childrens Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia. caroline.crowther@adelaide.edu.au. (Editorial group: Cochrane Pregnancy and Childbirth Group.) Cochrane Database of Systematic Reviews, Issue 3, 2009 (Status in this issue: Unchanged) Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. DOI: 10.1002/14651858.CD000110 This version rst published online: 22 January 2001 in Issue 1, 2001. Last assessed as up-to-date: 30 September 2000. (Help document - Dates and Statuses explained) This record should be cited as: Crowther CA. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000110. DOI: 10.1002/14651858.CD000110.
ABSTRACT Background Bed rest used to be widely advised for women with a multiple pregnancy. Objectives The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes. Search strategy The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of relevant articles were searched. Date of last search: August 2000. Selection criteria Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred. Data collection and analysis Assessment for inclusion and methodological quality of the trials was done by the reviewer. Data were extracted by the reviewer and double entered. All eligible trials were included in the initial analysis. Prespecied sensitivity analyses have been carried out to evaluate the effect of trial quality, the effects of hospitalisation for bed rest in women with an uncomplicated twin pregnancy, in women with a triplet pregnancy and in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. Main results Six trials were included which involved over 600 women and 1400 babies. (1) Analyses of all trials. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was a trend to a decreased number of low birth weight infants born to women in the routinely hospitalised group, which became signicant when the trial using alternate allocation was excluded (odds ratio (OR) 0.79; 95% condence interval (CI) 0.63-0.99). No differences were
Hospitalisation and bed rest for multiple pregnancy (Review) Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 1
seen in the number of very low birth weight infants. No support for the policy was found in other neonatal outcomes. No information is available on developmental outcomes for infants in any of the trials. Womens views about the care they received were reported rarely. (2) Analyses of hospitalisation for bed rest in women with an uncomplicated twin pregnancy. The risk of preterm birth was not reduced. Indeed signicantly more women gave birth very preterm (< 34 weeks gestation) (OR 1.84; 95% CI 1.01-3.34). No differences were seen in perinatal mortality, or in other neonatal outcomes. Women receiving hospitalisation for bed rest had a decreased risk of developing hypertension (OR 0.55; 95% CI 0.32-0.97), although this effect was no longer apparent when the trial using alternate allocation was excluded. (3) Analyses of hospitalisation for bed rest in women with a triplet pregnancy. Most of the comparisons made between the hospitalised and control groups suggest benecial treatment effects from routine hospitalisation for bed rest. However all the differences observed between the experimental and control groups were compatible with chance variation. (4) Analyses of hospitalisation for bed rest in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. No differences were seen in the risk of preterm birth, perinatal mortality, fetal growth or in other neonatal outcomes. Authors conclusions There is currently not enough evidence to support a policy of routine hospitalisation for bed rest in multiple pregnancy. No reduction in the risk of preterm birth or perinatal death is evident, although there is a suggestion that fetal growth is improved. For women with an uncomplicated twin pregnancy the results of this review suggest that it may be harmful in that the risk of very preterm birth is increased. Until further evidence is available to the contrary, the policy cannot be recommended for routine clinical practice.
PLAIN LANGUAGE SUMMARY Hospitalisation and bed rest for multiple pregnancy No strong evidence that bed rest in hospital for women with a multiple pregnancy decreases the risk of a preterm birth. Multiple pregnancy has a higher risk of preterm (early) birth and poor growth of infants during pregnancy than single pregnancies. Bed rest has been widely used to decrease these risks and to improve the babys growth. The review of trials found routine bed rest in hospital did not decrease the risk of a preterm birth, but may improve growth of the infants. Bed rest may be harmful as more women with an uncomplicated twin pregnancy gave birth very preterm. Benets of bed rest in hospital for women with triplets were seen but these could equally have been due to chance.
BACKGROUND
Multiple pregnancy is associated with increased fetal and neonatal mortality compared with singleton pregnancy and morbidity is high amongst survivors. The higher the order of multiple pregnancy the greater the risk of mortality and morbidity. The majority of perinatal deaths are associated with preterm birth and intrauterine growth restriction. Fetal growth is reduced from 2730 weeks in twins and from the 27th week in triplets compared with singletons (McKeown 1952). Interventions for multiple pregnancy that reduce the risk of early birth and/or the risk of poor fetal growth would be an important advance in care. Based on observational studies in the early 1950s that identied improved perinatal outcome in twins born to middle class women (Russell 1952), the suggestion that admitting to hospital all twin mothers at the 30th week in order by diet and rest to tide them over the danger period became widely accepted into obstetric practice. No evidence was produced to show the benets expected from such a practice. Hospitalisation is often a disruptive and stressful experience for women and their families. In addition, hospitalisation is costly to the health services. Women at especially high risk of preterm birth might be expected
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to derive greatest benet from hospitalisation for bed rest if effective. Benecial effects of hospitalisation for bed rest might include prolongation of pregnancy to achieve greater fetal maturation at birth, improvement in fetal growth and optimal intrapartum management, as labour if early would begin in hospital. Women with a triplet or higher order multiple pregnancy have an increased risk of preterm birth and intrauterine growth restriction compared with women having twins. Similarly, women with a twin pregnancy who have evidence on cervical assessment of cervical effacement and dilatation (low cervical score) are at increased risk of preterm birth compared with women who have an uncomplicated twin pregnancy (Houlton 1982; Neilson 1988). For additional background information please refer to Crowther 1989a.
Search methods for identication of studies

Electronic searches This review has drawn on the search strategy developed for the Pregnancy and Childbirth Group as a whole. Relevant trials were identied in the Groups Specialised Register of Controlled Trials. See Review Groups details for more information. The Cochrane Controlled Trials Register was searched using the terms hospitali* near pregnancy, multiple pregnancy, twin near pregnancy, triplets. Date of last search: August 2000.
Data collection and analysis

Included trial data were processed as described in Clarke 2000. Trials under consideration were evaluated for inclusion and methodological quality. There was no blinding of authorship. Quality scores for concealment of allocation were assigned to each trial, using the criteria described in Section 6 of the Cochrane Handbook (Clarke 2000) A = adequate, B = unclear, C = inadequate, D = not used. In addition, quality scores were assigned to each trial for completeness of follow-up and blinding of outcome assessment as follows:Completeness of follow-up: (A) < 3% of participants excluded; (B) 3% - 9.9% of participants excluded; (C) 10% - 19.9% of participants excluded; (D) 20% or more excluded; (E) unclear. For blinding of assessment of outcome: (A) Double-blind, neither investigator nor participant knew or were likely to guess the allocated treatment. (B) Single-blind, either the investigator or the participant knew the allocation. Or, the trial is described as double-blind, but side effects of one or other treatment mean that it is likely that for a signicant proportion (>= 20%) of participants the allocation could be correctly identied. (C) No blinding, both investigator and participant knew (or were likely to guess) the allocated treatment. (D) Unclear. Data were extracted by the reviewer and double entered. There was no blinding of authorship. Whenever possible, unpublished data were sought from investigators. Descriptive data included authors, year of publication, setting, country, time span of the trial, pretrial calculation of sample size and number randomised and analysed. Categorical data were compared using odds ratio (OR) and 95% condence intervals (CI). Statistical heterogeneity between trials was tested for using the chisquared test with n (the number of trials contributing data) minus
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OBJECTIVES
To evaluate the effect of hospitalisation for bed rest in women with a multiple pregnancy on the risk of preterm birth, fetal and neonatal mortality, neonatal morbidity, and womens satisfaction with their care.
METHODS
Criteria for considering studies for this review

Types of studies All published, unpublished and ongoing randomised trials with reported data which compare outcomes in women and their babies who were offered hospitalisation for bed rest during pregnancy compared with women who did not receive routine hospitalisation. Types of participants Women with a multiple pregnancy. Types of interventions Hospitalisation for bed rest during the antenatal period compared with a policy of selective admission. Types of outcome measures The primary outcomes are preterm birth, perinatal mortality, and fetal growth. Secondary outcomes include other neonatal morbidity, long term disability, maternal morbidity and womens assessment of their care.
one degrees of freedom. With no signicant heterogeneity (p > 0.10), data were pooled using a xed effects model. If signicant heterogeneity was found, the random effects model was used. All eligible trials were included in the initial analysis and sensitivity analyses have been carried out to evaluate the effect of trial quality. This was done by excluding trials given a D rating for quality for allocation concealment. Further analyses explored the effect of hospitalisation for bed rest in women with an uncomplicated twin pregnancy, in women with a triplet pregnancy and women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour.
1. Analyses of all trials. A policy of routine hospitalisation for bed rest in multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was a trend to a decreased number of low birth weight infants in the routinely hospitalised group which reached the conventional levels of statistical signicance when the trial given a D rating for concealment of allocation (Hartikainen-Sorri) was excluded (odds ratio (OR) 0.79; 95% condence interval (CI) 0.630.99). No differences were seen in the number of very low birth weight infants. No support for the policy was found in other neonatal outcomes which included depressed Apgar scores (< 7), need for admission and length of stay of seven days or more on the neonatal unit. No information was available on developmental outcomes for infants in any of the trials. A trend to a decreased risk of developing hypertension in women receiving routine hospitalisation for bed rest was shown (OR 0.61; 95% CI 0.37-1.00), but the condence limits around the point estimate crossed one when the trial given a D rating for concealment of allocation (Hartikainen-Sorri) was excluded. This observation was open to observer bias and needs to be interpreted cautiously. One trial provided information about what women in the routinely hospitalised group thought about their care (Maclennan 1990): only 6% appreciated admission and 18% found hospitalisation for bed rest psychologically distressing. 2. Analyses of hospitalisation for bed rest in women with an uncomplicated twin pregnancy. The risk of preterm birth was not reduced. Indeed signicantly more women gave birth very preterm (< 34 weeks gestation) (OR 1.84; 95% CI 1.01-3.34), and there was a trend for a lower mean gestational age at birth in women who received routine hospitalisation. No differences were seen in perinatal mortality. In keeping with the increased risk of very preterm birth there were more very low birth weight infants in the routinely hospitalised group (OR 1.93; 95% CI 1.05-3.53) although this effect was no longer apparent when the trial given a D rating for concealment of allocation (Hartikainen-Sorri) was excluded. No differences were seen in other neonatal outcomes. Women receiving hospitalisation for bed rest had a decreased risk of developing hypertension (OR 0.55; 95% CI 0.32-0.97) although this effect was no longer apparent when the trial given a D rating for concealment of allocation (Hartikainen-Sorri) was excluded. 3. Analyses of hospitalisation for bed rest in women with a triplet pregnancy.
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RESULTS
Description of studies
See: Characteristics of included studies; Characteristics of excluded studies. Seven trials of antenatal hospitalisation for bed rest for women with a multiple pregnancy have been identied of which six meet the selection criteria. In the excluded trial all women in the study were in hospital for bed rest (Gummerus 1985). A further two studies are awaiting assessment as to whether they are randomised trials, as their primary reports are unclear about this (Younis 1990; al-Najashi 1996). The six included trials involved over 600 women and 1400 babies. Five trials of hospitalisation for bed rest involve women with a twin pregnancy and one woman with a triplet pregnancy . Details of each study are given in the Table of Characteristics of Included Studies.
Risk of bias in included studies

All except one of the trials (Hartikainen-Sorri) used formal randomisation. A central telephone agency was used in Maclennan 1990, and sealed envelopes in Saunders 1985, Crowther 1989 , Crowther 1990, Crowther 1991. Allocation concealment was not met in the Hartikainen-Sorri trial as they used quazi-randomisation utilising odd or even year of birth. No blinding to the intervention occurred. The primary outcome of gestational age at birth was assessed by a paediatrician blinded to treatment group in Crowther 1989, Crowther 1990, and Crowther 1991. All other trials make no comment of blinding of outcome assessments. The rate of exclusion after randomisation was low in most of the trials. The highest rate reported was 8% for Hartikainen-Sorri.
Effects of interventions
Most of the comparisons made between the hospitalised and control groups suggest benecial treatment effects from routine hospitalisation for bed rest. However, as the condence limits around these treatment effects are wide, all the differences observed between the experimental and control groups were compatible with chance variation. The data show a trend to a decreased incidence of very low birth weight infants in the hospitalised group. 4. Analyses of hospitalisation for bed rest in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. No differences were seen in the risk of preterm birth, perinatal mortality, fetal growth, or other neonatal outcomes.
AUTHORS CONCLUSIONS Implications for practice

There is currently no sound evidence to support a policy of routine hospitalisation for bed rest in multiple pregnancy. For women with an uncomplicated twin pregnancy the results of this review suggest that such a policy may be harmful in that the risk of very preterm birth was increased. Until further evidence is available to the contrary, the policy cannot be recommended for routine clinical practice. In women with triplets, although mainly benecial effects of the policy were observed, it must be reiterated that these could all be ascribed to chance variation, and do not provide a basis for adoption of the policy into clinical practice. For women with a twin pregnancy at high risk of preterm birth, because of signs of cervical effacement and dilatation prior to labour, there is, so far, no basis for the adoption of the policy into clinical practice.
DISCUSSION
There is currently no sound evidence to support a policy of routine hospitalisation for bed rest for women with a multiple pregnancy. No reduction in the risk of preterm birth or perinatal death is evident, although there is a suggestion that fetal growth is improved. The available evidence suggests the policy may be harmful for women with an uncomplicated twin pregnancy because of an increased risk of very preterm birth.
Implications for research

Hospitalisation for bed rest in multiple pregnancy was introduced into clinical practice without adequate controlled evaluation of its efcacy. The policy has been subjected to limited well-controlled evaluation, and to clarify further the benecial or adverse effects, additional, controlled evaluation is necessary. Evaluation of the policy in women considered at higher than average risk of preterm birth and at gestational ages considered at greatest risk would seem appropriate. Further assessment of the favourable effects on fetal growth observed is warranted. Four of the six trials were conducted in Harare, Zimbabwe. The effect of the policy needs to be known in other obstetric populations and other racial groups. Any future trials should provide long term developmental outcomes for the infants, assess womens views of the care received, test the hypothesis that women receiving hospitalisation for bed rest have a decreased risk of developing hypertension, and assess costs. For women with a triplet pregnancy the policy has not been fully evaluated, and an international, multi centred, trial would be necessary.
There has been no long term follow-up of developmental outcome of infants in any of the trials to date. Similarly there is a paucity of information about how women and their families feel about this form of care. The information available suggests that many women nd routine hospitalisation distressing. The suggestion of a decreased risk of developing hypertension in women with a multiple pregnancy receiving hospitalisation for bed rest was an unpredicted observation and interpretation must be cautious, especially as the observation is easily subject to observer bias. Any future trials should test this hypothesis. These six trials provide only limited evaluation of the policy of routine hospitalisation for bed rest in multiple pregnancy and provide no good evidence to support the use of the policy. Four of the six trials were conducted in Harare, Zimbabwe. The effect of the policy should be known for other obstetric populations and other racial groups.
The scanty evidence available for women with a triplet pregnancy highlights the need for further research to help clarify whether there are real benets of hospitalisation that outweigh the social and nancial costs. To ensure a trial of adequate size to be able to detect small but clinically important differences, a multinational, multi centred collaborative trial is needed.
ACKNOWLEDGEMENTS
Dr Anna-Liisa Hartikainen-Sorri kindly provided additional unpublished data for the review, and the reviewer provided additional data from her MD thesis.
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The reviews that have been combined into this systematic review were rst published on the Oxford Database of Perinatal Trials in 1987. The opportunity for three of the trials reviewed to be completed, the preparation of the initial systematic reviews, and the continued updating were made possible by the encouragement and support given by Iain and Jan Chalmers, Jini Hetherington and staff at the National Perinatal Epidemiology Unit, Oxford.
REFERENCES
References to studies included in this review

Crowther 1989 {published data only} Crowther CA, Neilson JP, Verkuyl DAA, Bannerman C, Ashurst HM. Preterm labour in twin pregnancies: can it be prevented by hospital admission?. British Journal of Obstetrics and Gynaecology 1989;96:8503. Crowther 1990 {published data only} Crowther CA, Verkuyl DAA, Neilson JP, Bannerman C, Ashurst HM. The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy. British Journal of Obstetrics and Gynaecology 1990;97:8727. Crowther 1991 {published data only} Crowther CA, Verkuyl D, Ashworth M, Bannerman C, Ashurst H. The effects of hospitalisation for bed rest on duration of gestation, fetal growth and neonatal morbidity in triplet pregnancy. Acta Genet Med Gemellol 1991;40:638. Hartikainen-Sorri {published data only} Hartikainen-Sorri AL, Jouppila P. Is routine hospitalization needed in antenatal care of twin pregnancy?. Journal of Perinatal Medicine 1984;12:314. Maclennan 1990 {published data only} MacLennan AH, Green RC, OShea R, Brookes C, Morris D. Routine hospital admission in twin pregnancy between 26 and 30 weeks gestation. Lancet 1990;335:2679. Saunders 1985 {published data only} Saunders MC, Dick JS, Brown I McL, McPherson K, Chalmers I. The effects of hospital admission for bed rest on the duration of twin pregnancy: a randomised trial. Lancet 1985;2:7935.
al-Najashi 1996 {published data only} al-Najashi SS, al-Mulhim AA. Prolongation of pregnancy in multiple pregnancy. International Journal of Gynaecology and Obstetrics 1996;54(2):1315. Younis 1990 {published data only} Younis JS, Sadovsky E, Eldar-Geva T, Mildwidsky A, Zeevi D, Zajicek G. Twin gestations and prophylactic hospitalization. International Journal of Gynaecology and Obstetrics 1990;32(4):32530.
Additional references
Clarke 2000 Clarke M, Oxman AD, editors. Cochrane Reviewers Handbook 4.1 [updated June 2000]. In: Review Manager (RevMan) [Computer program]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000. Crowther 1989a Crowther CA, Chalmers I. Bed rest and hospitalization during pregnancy. In: Chalmers I, Enkin MW, Keirse MJNC editor(s). Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989:62432. Houlton 1982 Houlton MCC, Marivate M, Philpott RHP. Factors associated with preterm labour and changes in the cervix before labour in twin pregnancy. British Journal of Obstetrics and Gynaecology 1982;89:1904. McKeown 1952 McKeown T, Record R. Observation on fetal growth in multiple pregnancy in man. Journal of Endocrinology 1952;8:386401. Neilson 1988 Neilson JP, Verkuyl DAA, Crowther CA, Bannerman C. Preterm labour in twin pregnancies: Prediction by cervical assessment. Obstetrics and Gynecology 1988;72:71923. Russell 1952 Russell J. Maternal and fetal hazards associated with twin pregnancy. J Obstet Gynaecol Brit Commwlth 1952;59:20813.
References to studies excluded from this review

Gummerus 1985 {published data only} Gummerus M, Halonen O. Prophylactic long-term oral tocolysis of multiple pregnancies. British Journal of Obstetrics and Gynaecology 1987;94(3):24951. Gummerus M, Halonen O. The merits of betamimetic treatment and bed rest in multiple pregnancies [Vuodelevon ja beetasympatomimeetthoidon vaikutus monisikioisessa raskaudessa]. Duodecim 1985;101:196671.
References to other published versions of this review

Crowther 1991a Crowther CA. Hospitalisation for bed rest in multiple pregnancy.. In: Chalmers I (ed) Oxford Database of Perinatal Trials. Version 1.2. Disk Issue 6, Autumn 1991.
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References to studies awaiting assessment
Crowther 1991b Crowther CA. Hospitalisation for bed rest in twin pregnancy.. In: Chalmers I (ed) Oxford Database of Perinatal Trials. Version 1.2. Disk Issue 6, Autumn 1991. Crowther 1991c Crowther CA. Hospitalisation for bed rest in triplet pregnancy.. In: Chalmers I (ed) Oxford Database of Perinatal Trials. Version 1.2. Disk Issue 6, Autumn 1991. Crowther 1991d Crowther CA. Hospitalisation for cervical dilatation in twin pregnancy.. In: Chalmers I (ed) Oxford Database of Perinatal Trials. Version 1.2. Disk Issue 6, Autumn 1991. Crowther 1995a Crowther CA. Hospitalisation for bed rest in multiple pregnancy. [revised 05 October 1993] In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995. Crowther 1995b Crowther CA. Hospitalisation for bed rest in triplet pregnancy. [revised 05 October 1993] In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Crowther 1995c Crowther CA. Hospitalisation for bed rest in twin pregnancy. [revised 05 October 1993] In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995. Crowther 1995d Crowther CA. Hospitalisation for cervical dilation in twin pregnancy. [revised 05 October 1993] In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995. Crowther 1997 Crowther CA. Hospitalisation for bedrest in multiple pregnancy. In: Neilson JP, Crowther CA, Hodnett ED, Hofmeyr GJ (eds.) Pregnancy and Childbirth Module of The Cochrane Database of Systematic Reviews , [updated 01 September 1997]. Available in The Cochrane Library [database on disk and CDROM]. The Cochrane Collaboration; Issue 3. Oxford: Update Software; 1997. Updated quaterly. Crowther 1999 Crowther CA. Hospitalisation and bed rest for multiple pregnancy (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. Indicates the major publication for the study
CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]

Crowther 1989 Methods Single centre in Harare, Zimbabwe. Randomisation by opening consecutively, opaque, sealed envelopes. Block randomisation prepared by a researcher not involved in treatment allocation. Outcome assessment of gestational age by paediatrician blinded to treatment allocation. No losses to follow-up. 139 women with a twin pregnancy with a cervical score of -2 or less on vaginal examination at or before 34 weeks gestation, who attended a specialist antenatal clinic for multiple pregnancy. Exclusion criteria included uncertain gestational age, cervical suture in place, antepartum haemorrhage, hypertension, previous caesarean section and in labour. Women allocated to the hospitalisation group were admitted to the antenatal ward as soon after randomisation as convenient. Women were encouraged to rest in bed as much as possible, but ambulation was allowed. Women allocated to the control group were not routinely admitted and were encouraged to continue their normal activities at home. Women were selectively admitted if problems developed (preterm labour, hypertension, preterm prelabour rupture of the membranes). Primary outcomes: gestational age at delivery (Dubowitz assessment by paediatrician blinded to treatment allocation), birth weight, need for admission to neonatal intensive care unit. Other neonatal morbidity, perinatal mortality. Maternal morbidity. Sample size of 44 women would have an 80% chance of detecting a reduction in rate of preterm delivery from 80% to 40% at the 5% level.
Participants
Interventions
Outcomes
Notes
Risk of bias Item Allocation concealment? Authors judgement Yes Description A - Adequate
Crowther 1990 Methods Single centre in Harare, Zimbabwe. Randomisation by opening consecutively, opaque, sealed envelopes. Block randomisation prepared by a researcher not involved in treatment allocation. Outcome assessment of gestational age by paediatrician blinded to treatment allocation. No exclusions. No losses to follow-up. 118 women with a twin pregnancy at 28-30 weeks gestation who attended a specialist antenatal clinic for multiple pregnancy. Exclusion criteria included uncertain gestational age, cervical suture in place, antepartum haemorrhage, hypertension, or previous caesarean section. Women allocated to the hospitalisation group were admitted to the antenatal ward as soon after randomisation as convenient. Women were encouraged to rest in bed as much as possible, but ambulation was allowed. Women allocated to the control group were not routinely admitted and were encouraged to continue their normal activities at home. Women were selectively admitted if problems developed (hypertension, preterm prelabour rupture of the membranes, preterm labour). Primary outcomes: gestational age at delivery (Dubowitz assessment by paediatrician blinded to treatment allocation), birth weight, need for admission to neonatal intensive care unit. Other neonatal morbidity, perinatal mortality. Maternal morbidity. Sample size of 100 women would detect a reduction in rate of preterm delivery from 55% to 28%. 200 women would be needed to detect a reduction in the risk of small for gestational age infants from 35% to 17.5%.
Participants
Interventions
Outcomes
Notes
Crowther 1991 Methods Single centre in Harare, Zimbabwe. Randomisation by opening consecutively, opaque, sealed envelopes. Block randomisation prepared by a researcher not involved in treatment allocation. Outcome assessment of gestational age by paediatrician blinded to treatment allocation. No losses to follow-up. 19 women with a triplet pregnancy at 24 weeks gestation or more who attended a specialist antenatal clinic for multiple pregnancy. Exclusion criteria included uncertain gestational age, cervical suture in place, antepartum haemorrhage, hypertension, or previous caesarean section.
Participants
Crowther 1991
(Continued)
Interventions
Women allocated to the hospitalisation group were asked to attend the antenatal ward as soon after recruitment as possible. Women were encouraged to rest in bed as much as possible, but ambulation was allowed. Women allocated to the control group were not routinely admitted and were encouraged to continue their normal activities at home. Women were selectively admitted if problems developed (hypertension, preterm prelabour rupture of the membranes, preterm labour). Gestational age at delivery (Dubowitz assessment by paediatrician blinded to treatment allocation), birth weight, other neonatal morbidity, perinatal mortality. Maternal morbidity. No pretrial sample size calculation.
Outcomes
Notes Risk of bias Item Allocation concealment?
Authors judgement Yes
Description A - Adequate
Hartikainen-Sorri Methods Single centre, Oulu, Finland. Randomisation by odd/even year of birth, (quazi-randomised). Exclusions 8%. 73 women with a twin pregnancy, conrmed by ultrasound, attending out-patient clinic. Women allocated to bed rest were admitted to hospital for rest after the 29th week of gestation. Women allocated to the control group were seen weekly in the specialised antenatal clinic. Selective admission if in preterm labour, fetal distress developed or hypertension. Gestational age at delivery, birth weight, perinatal mortality, fetal distress, maternal hypertension. One set of conjoined twins excluded from the bed rest group. Additional data kindly provided by Dr Anna-Liisa Hartikainen-Sorri. No sample size given.
Participants Interventions
Outcomes Notes
Risk of bias Item Allocation concealment? Authors judgement No Description C - Inadequate
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Maclennan 1990 Methods Multicentred, 11 hospitals in Australia. Randomisation: enrolment by telephone by a central agency. A random allocation of management was given to the clinician in charge from a computer-generated list of random numbers; the person designating the management was unaware of the management associated with the number until after enrolment. No exclusions. 141 women with twin pregnancy, conrmed by ultrasound. Randomised between 16-19 weeks gestation. Exclusion criteria: not able to be admitted, pre-existing hypertension, polyhydramnios, antepartum haemorrhage, preterm prelabour rupture of the membranes, preterm labour. Women allocated to bed rest were admitted at 26 weeks gestation for 4 weeks. Weekend leave was allowed. Strict bed rest was not advocated. Women allocated to the control group were not routinely admitted but seen in the clinic every two weeks. Normal home activities were encouraged. Gestational age at delivery, birth weight, need for admission and length of stay on the neonatal ward. Womens views of care. Sample size 400 women in each arm to detect differences in mortality and major handicap.
Participants
Interventions
Outcomes
Notes Risk of bias Item Allocation concealment?
Authors judgement Yes
Description A - Adequate
Saunders 1985 Methods Single centre in Harare, Zimbabwe. Randomisation: consecutively numbered series of sealed envelopes. No losses to follow-up reported. 212 women with a twin pregnancy attending the antenatal clinic. Randomised (usually 30 weeks) at their last antenatal visit before admission at 32 weeks gestation. Women allocated to bed rest in hospital were admitted for bed rest at 32 weeks gestation until the onset of labour. Women allocated to the control group were not routinely admitted to hospital. Selective admission only for complications. Gestational age at delivery, birth weight, perinatal mortality, hypertension. 100 women in each arm had a 40% chance of detecting a reduction in the risk of preterm delivery before 37 weeks gestation by one third, from 30% to 20%.
Participants
Interventions
Outcomes Notes
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Saunders 1985
(Continued)
Characteristics of excluded studies [ordered by study ID]
Gummerus 1985
This randomised trial of 200 women in Finland compared the effects on gestation at birth and birth weight of long-term betamimetic therapy given to women with a multiple pregnancy after admission to hospital for bed rest with no betamimetic therapy. All women were admitted to hospital for bed rest and the trial therefore did not meet the criteria for inclusion.
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DATA AND ANALYSES
Comparison 1. Hospitalisation for bed rest for women with a multiple pregnancy
Outcome or subgroup title 1 Perinatal death 2 Stillbirth 3 Early neonatal death 4 Gestational age at delivery 5 Preterm delivery (< 37 weeks) 6 Very preterm delivery (< 34 weeks) 7 Birthweight twinI/triplet I 8 Birthweight twinII/triplet II 9 Low birth weight (< 2500g) 10 Very low birth weight (< 1500g) 11 Prelabour preterm rupture of the membranes 12 Spontaneous onset of labour 13 Caesarean delivery 14 Apgar score < 7 at 1 minute 15 Apgar score < 7 at 5 minutes 16 Admission to neonatal care unit 17 Neonatal stay => 7days 18 Any neurodevelopmental abnormality at follow-up 19 Development of maternal hypertension 20 Womens satisfaction with care
No. of studies 6 6 6 6 6 4 4 4 6 6 4 5 4 6 4 4 3 0 6 0
No. of participants 1427 1431 1431 706 706 417 417 417 1431 1431 417 629 417 1431 853 853 571 0 706 0
Statistical method Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI)
Effect size 1.14 [0.65, 2.01] 0.89 [0.43, 1.85] 1.81 [0.73, 4.49] -0.26 [-0.59, 0.07] 1.14 [0.82, 1.58] 1.37 [0.85, 2.21] 0.08 [-0.02, 0.18] 0.07 [-0.02, 0.17] 0.83 [0.67, 1.03] 1.36 [0.82, 2.25] 1.44 [0.83, 2.50] 2.19 [1.12, 4.28] 0.91 [0.56, 1.46] 0.80 [0.61, 1.04] 1.07 [0.59, 1.96] 0.87 [0.65, 1.17] 0.85 [0.56, 1.29] Not estimable 0.61 [0.37, 1.00] Not estimable
Comparison 2. Hospitalisation for bed rest for women with an uncomplicated twin pregnancy
Outcome or subgroup title 1 Perinatal death 2 Stillbirth 3 Early neonatal death 4 Gestational age at delivery 5 Preterm delivery (< 37 weeks) 6 Very preterm delivery (< 34 weeks) 7 Birthweight twinI/triplet I 8 Birthweight twinII/triplet II
No. of studies 4 4 4 4 4 2 2 2
No. of participants 1092 1096 1096 548 548 259 259 259
Statistical method Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI)
Effect size 1.31 [0.70, 2.43] 0.82 [0.38, 1.77] 2.84 [1.02, 7.87] -0.39 [-0.78, 0.01] 1.31 [0.92, 1.89] 1.84 [1.01, 3.34] 0.06 [-0.07, 0.19] 0.05 [-0.09, 0.18]
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9 Low birth weight (< 2500g) 10 Very low birth weight (< 1500g) 11 Prelabour preterm rupture of the membranes 12 Spontaneous onset of labour 13 Caesarean delivery 14 Apgar score < 7 at 1 minute 15 Apgar score < 7 at 5 minutes 16 Admission to neonatal care unit 17 Neonatal stay => 7days 18 Any neurodevelopmental abnormality at follow-up 19 Development of maternal hypertension 20 Womens satisfaction with care
4 4 2 3 2 4 2 2 1 0 4 0
1096 1096 259 471 259 1186 518 518 236 0 548 0
Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI)
0.83 [0.65, 1.06] 1.93 [1.05, 3.53] 1.57 [0.76, 3.23] 2.03 [0.98, 4.18] 1.00 [0.58, 1.72] 1.04 [0.77, 1.42] 0.79 [0.39, 1.63] 1.12 [0.76, 1.66] 0.65 [0.32, 1.33] Not estimable 0.55 [0.32, 0.97] Not estimable
Comparison 3. Hospitalisation for bed rest for women with a triplet pregnancy
Outcome or subgroup title 1 Perinatal death 2 Stillbirth 3 Early neonatal death 4 Gestational age at delivery 5 Preterm delivery (< 37 weeks) 6 Very preterm delivery (< 34 weeks) 7 Birthweight triplet I 8 Birthweight triplet II 9 Birthweight triplet III 10 Low birth weight (< 2500g) 11 Very low birth weight (< 1500g) 12 Prelabour preterm rupture of the membranes 13 Spontaneous onset of labour 14 Caesarean delivery 15 Apgar score < 7 at 1 minute 16 Apgar score < 7 at 5 minutes 17 Admission to neonatal care unit 18 Neonatal stay => 7days 19 Any neurodevelopmental abnormality at follow-up 20 Development of maternal hypertension 21 Womens satisfaction with care
No. of studies 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0
No. of participants 57 57 57 19 19 19 19 19 19 57 57 19 19 19 57 57 57 57 0 19 0
Statistical method Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI)
Effect size 0.31 [0.04, 2.33] 6.69 [0.13, 338.79] 0.12 [0.01, 1.92] 0.70 [-1.43, 2.83] 0.13 [0.01, 2.33] 0.56 [0.09, 3.42] 0.17 [-0.23, 0.57] 0.04 [-0.19, 0.27] 0.32 [-0.13, 0.77] 0.13 [0.02, 1.01] 0.55 [0.14, 2.12] 0.26 [0.03, 2.27] Not estimable 7.48 [0.43, 130.05] 0.49 [0.14, 1.66] 6.69 [0.13, 338.79] 0.43 [0.09, 2.07] 1.87 [0.67, 5.24] Not estimable 0.26 [0.03, 2.27] Not estimable
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Comparison 4. Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy
Outcome or subgroup title 1 Perinatal death 2 Stillbirth 3 Early neonatal death 4 Gestational age at delivery 5 Preterm delivery (< 37 weeks) 6 Very preterm delivery (< 34 weeks) 7 Birthweight twin I 8 Birthweight twin II 9 Low birth weight (< 2500g) 10 Very low birth weight (< 1500g) 11 Prelabour preterm rupture of the membranes 12 Spontaneous onset of labour 13 Caesarean delivery 14 Apgar score < 7 at 1 minute 15 Apgar score < 7 at 5 minutes 16 Admission to neonatal care unit 17 Neonatal stay => 7days 18 Any neurodevelopmental abnormality at follow-up 19 Development of maternal hypertension 20 Womens satisfaction with care
No. of studies 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0
No. of participants 278 278 278 139 139 139 139 139 278 278 139 139 139 278 278 278 278 0 139 0
Statistical method Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Mean Difference (IV, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI) Peto Odds Ratio (Peto, Fixed, 95% CI)
Effect size 0.99 [0.14, 7.07] 0.99 [0.06, 15.84] 0.99 [0.06, 15.84] Not estimable 0.69 [0.32, 1.50] 0.89 [0.36, 2.16] 0.10 [-0.06, 0.26] 0.13 [-0.02, 0.28] 0.91 [0.56, 1.47] 0.65 [0.18, 2.30] 1.72 [0.68, 4.33] 3.49 [0.59, 20.69] 0.47 [0.16, 1.36] 0.67 [0.36, 1.23] 1.97 [0.62, 6.26] 0.65 [0.40, 1.04] 0.78 [0.43, 1.41] Not estimable 1.17 [0.37, 3.63] Not estimable
15
Analysis 1.1. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 1 Perinatal death.
Review: Hospitalisation and bed rest for multiple pregnancy
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 1 Perinatal death
Study or subgroup
Treatment n/N
Control n/N 2/138 12/120 3/27 0/90 2/144 5/214
Peto Odds Ratio Peto,Fixed,95% CI
Weight
Crowther 1989 Crowther 1990 Crowther 1991 Hartikainen-Sorri Maclennan 1990 Saunders 1985
2/140 4/112 1/30 3/64 8/138 8/210
8.3 % 31.2 % 7.9 % 6.0 % 20.2 % 26.4 %
0.99 [ 0.14, 7.07 ] 0.37 [ 0.13, 1.02 ] 0.31 [ 0.04, 2.33 ] 11.45 [ 1.14, 115.52 ] 3.61 [ 1.02, 12.74 ] 1.64 [ 0.54, 4.94 ]
Total (95% CI)
694
733
100.0 %
1.14 [ 0.65, 2.01 ]
Total events: 26 (Treatment), 24 (Control) Heterogeneity: Chi2 = 13.84, df = 5 (P = 0.02); I2 =64% Test for overall effect: Z = 0.46 (P = 0.65)
0.1 0.2
0.5
10
16
Analysis 1.2. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 2 Stillbirth.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 2 Stillbirth
Study or subgroup
Treatment n/N
Control n/N 1/138 11/120 0/27 0/90 1/144 3/214
Peto Odds Ratio Peto,Fixed,95% CI 0.99 [ 0.06, 15.84 ] 0.24 [ 0.08, 0.74 ] 6.69 [ 0.13, 338.79 ] 0.0 [ 0.0, 0.0 ] 4.06 [ 0.81, 20.42 ] 1.69 [ 0.42, 6.86 ]
1/140 2/116 1/30 0/64 5/138 5/210
Total (95% CI)

Total events: 14 (Treatment), 16 (Control)
698
733
0.89 [ 0.43, 1.85 ]
Heterogeneity: Chi2 = 10.50, df = 4 (P = 0.03); I2 =62% Test for overall effect: Z = 0.30 (P = 0.76)
0.1 0.2
0.5
10
17
Analysis 1.3. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 3 Early neonatal death.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 3 Early neonatal death
Study or subgroup
Treatment n/N
Control n/N 1/138 1/120 2/27 0/90 1/144 2/214
Weight
1/140 2/116 0/30 3/64 3/138 3/210
10.7 % 15.9 % 10.5 % 15.4 % 21.1 % 26.5 %
0.99 [ 0.06, 15.84 ] 2.03 [ 0.21, 19.69 ] 0.12 [ 0.01, 1.92 ] 11.45 [ 1.14, 115.52 ] 2.87 [ 0.40, 20.60 ] 1.53 [ 0.26, 8.89 ]
Total (95% CI)
698
733
100.0 %
1.81 [ 0.73, 4.49 ]
0.1 0.2
0.5
10
18
Analysis 1.4. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 4 Gestational age at delivery.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 4 Gestational age at delivery
Study or subgroup
Treatment N Mean(SD) 70 58 10 32 69 105 35.8 (1.9) 36.1 (2) 34.4 (2.2) 36.7 (2.4) 35.1 (3.2) 37.3 (2.2)
Control N 69 60 9 45 72 107 Mean(SD) 35.8 (1.9) 35.9 (2.1) 33.7 (2.5) 37.4 (1.8) 35.7 (2.6) 37.9 (2.5)
Mean Difference IV,Fixed,95% CI
Weight
27.4 % 20.0 % 2.4 % 11.3 % 11.7 % 27.2 %
0.0 [ -0.63, 0.63 ] 0.20 [ -0.54, 0.94 ] 0.70 [ -1.43, 2.83 ] -0.70 [ -1.68, 0.28 ] -0.60 [ -1.56, 0.36 ] -0.60 [ -1.23, 0.03 ]
Total (95% CI)
344
362
100.0 %
-0.26 [ -0.59, 0.07 ]
-10
-5
10
19
Analysis 1.5. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 5 Preterm delivery (< 37 weeks)
Study or subgroup
Treatment n/N
Control n/N 55/69 40/60 9/9 11/45 37/72 20/107
Weight
51/70 36/58 8/10 11/32 38/69 32/105
17.5 % 18.8 % 1.3 % 10.7 % 24.4 % 27.2 %
0.69 [ 0.32, 1.50 ] 0.82 [ 0.39, 1.74 ] 0.13 [ 0.01, 2.33 ] 1.62 [ 0.60, 4.38 ] 1.16 [ 0.60, 2.24 ] 1.88 [ 1.01, 3.52 ]
Total (95% CI)
344
362
100.0 %
1.14 [ 0.82, 1.58 ]
0.1 0.2
0.5
10
Analysis 1.6. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 6 Very preterm delivery (< 34 weeks)
Study or subgroup
Treatment n/N
Control n/N 12/69 11/60 4/9 10/72
Weight
Crowther 1989 Crowther 1990 Crowther 1991 Maclennan 1990
11/70 11/58 3/10 22/69
28.9 % 27.0 % 7.0 % 37.2 %
0.89 [ 0.36, 2.16 ] 1.04 [ 0.41, 2.62 ] 0.56 [ 0.09, 3.42 ] 2.77 [ 1.26, 6.07 ]
Total (95% CI)
207
210
100.0 %
1.37 [ 0.85, 2.21 ]
0.1 0.2
0.5
10
20
Analysis 1.7. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 7 Birthweight twinI/triplet I.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 7 Birthweight twinI/triplet I
Study or subgroup
Treatment N Mean(SD) 70 58 10 69 2.35 (0.45) 2.47 (0.49) 2.06 (0.45) 2.31 (0.67)
Control N 69 60 9 72 Mean(SD) 2.25 (0.53) 2.32 (0.39) 1.89 (0.43) 2.4 (0.6)
Weight
35.5 % 37.0 % 6.1 % 21.5 %
0.10 [ -0.06, 0.26 ] 0.15 [ -0.01, 0.31 ] 0.17 [ -0.23, 0.57 ] -0.09 [ -0.30, 0.12 ]
Total (95% CI)
207
210
100.0 %
0.08 [ -0.02, 0.18 ]
-10
-5
10
21
Analysis 1.8. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 8 Birthweight twinII/triplet II.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 8 Birthweight twinII/triplet II
Study or subgroup
Treatment N Mean(SD) 70 58 10 69 2.4 (0.46) 2.4 (0.45) 1.91 (0.25) 2.27 (0.73)
Control N 69 60 9 72 Mean(SD) 2.27 (0.47) 2.28 (0.47) 1.87 (0.27) 2.35 (0.56)
Weight
35.5 % 30.8 % 15.4 % 18.3 %
0.13 [ -0.02, 0.28 ] 0.12 [ -0.05, 0.29 ] 0.04 [ -0.19, 0.27 ] -0.08 [ -0.30, 0.14 ]
Total (95% CI)
207
210
100.0 %
0.07 [ -0.02, 0.17 ]
Heterogeneity: Chi2 = 2.84, df = 3 (P = 0.42); I2 =0.0% Test for overall effect: Z = 1.59 (P = 0.11)
-10
-5
10
Analysis 1.9. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 9 Low birth weight (< 2500g).
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 9 Low birth weight (< 2500g)
Study or subgroup
Treatment n/N
Control n/N 86/138 77/120 27/27 27/90 84/144 92/214
Weight
84/140 68/116 26/30 22/64 74/138 76/210
20.1 % 17.0 % 1.1 % 9.9 % 21.1 % 30.8 %
0.91 [ 0.56, 1.47 ] 0.79 [ 0.47, 1.34 ] 0.13 [ 0.02, 1.01 ] 1.22 [ 0.62, 2.43 ] 0.83 [ 0.52, 1.32 ] 0.75 [ 0.51, 1.11 ]
Total (95% CI)
698
733
100.0 %
0.83 [ 0.67, 1.03 ]
Total events: 350 (Treatment), 393 (Control) Heterogeneity: Chi2 = 4.75, df = 5 (P = 0.45); I2 =0.0% Test for overall effect: Z = 1.72 (P = 0.085)
0.1 0.2
0.5
10
22
Analysis 1.10. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 10 Very low birth weight (< 1500g).
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 10 Very low birth weight (< 1500g)
Study or subgroup
Treatment n/N
Control n/N 6/138 2/120 6/27 2/90 12/144 1/214
Weight
4/140 1/116 4/30 4/64 20/138 4/210
16.1 % 5.0 % 13.9 % 9.4 % 47.4 % 8.2 %
0.65 [ 0.18, 2.30 ] 0.53 [ 0.05, 5.13 ] 0.55 [ 0.14, 2.12 ] 2.91 [ 0.56, 15.17 ] 1.84 [ 0.88, 3.84 ] 3.42 [ 0.59, 19.93 ]
Total (95% CI)
698
733
100.0 %
1.36 [ 0.82, 2.25 ]
0.1 0.2
0.5
10
23
Analysis 1.11. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 11 Prelabour preterm rupture of the membranes
Study or subgroup
Treatment n/N
Control n/N 8/69 5/60 3/9 9/72
Weight
13/70 7/58 1/10 13/69
35.3 % 21.4 % 6.5 % 36.8 %
1.72 [ 0.68, 4.33 ] 1.50 [ 0.46, 4.93 ] 0.26 [ 0.03, 2.27 ] 1.61 [ 0.65, 3.99 ]
Total (95% CI)
207
210
100.0 %
1.44 [ 0.83, 2.50 ]
0.1 0.2
0.5
10
Analysis 1.12. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 12 Spontaneous onset of labour.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 12 Spontaneous onset of labour
Study or subgroup
Treatment n/N
Control n/N 65/69 56/60 9/9 60/72 101/107
Peto Odds Ratio Peto,Fixed,95% CI 3.49 [ 0.59, 20.69 ] 3.35 [ 0.56, 19.92 ] 0.0 [ 0.0, 0.0 ] 1.18 [ 0.48, 2.92 ] 7.61 [ 1.51, 38.44 ]
Crowther 1989 Crowther 1990 Crowther 1991 Maclennan 1990 Saunders 1985
69/70 57/58 10/10 59/69 105/105
Total (95% CI)
312
317
2.19 [ 1.12, 4.28 ]
0.1 0.2
0.5
10
24
Analysis 1.13. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 13 Caesarean delivery.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 13 Caesarean delivery
Study or subgroup
Treatment n/N
Control n/N 10/69 12/60 0/9 37/72
Weight
5/70 8/58 2/10 39/69
20.0 % 24.9 % 2.8 % 52.3 %
0.47 [ 0.16, 1.36 ] 0.65 [ 0.25, 1.68 ] 7.48 [ 0.43, 130.05 ] 1.23 [ 0.63, 2.38 ]
Total (95% CI)
207
210
100.0 %
0.91 [ 0.56, 1.46 ]
0.1 0.2
0.5
10
Analysis 1.14. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 14 Apgar score < 7 at 1 minute
Study or subgroup
Treatment n/N
Control n/N 29/138 36/120 8/27 10/90 50/144 21/214
Weight
21/140 22/116 5/30 10/64 42/138 24/210
19.2 % 20.4 % 4.7 % 7.9 % 29.0 % 18.8 %
0.67 [ 0.36, 1.23 ] 0.55 [ 0.31, 1.00 ] 0.49 [ 0.14, 1.66 ] 1.49 [ 0.57, 3.85 ] 0.82 [ 0.50, 1.35 ] 1.19 [ 0.64, 2.20 ]
Total (95% CI)
698
733
100.0 %
0.80 [ 0.61, 1.04 ]
0.1 0.2
0.5
10
25
Analysis 1.15. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 15 Apgar score < 7 at 5 minutes
Study or subgroup
Treatment n/N
Control n/N 4/138 15/120 0/27 3/144
Weight
8/140 7/116 1/30 7/138
27.3 % 47.4 % 2.4 % 22.9 %
1.97 [ 0.62, 6.26 ] 0.47 [ 0.19, 1.12 ] 6.69 [ 0.13, 338.79 ] 2.39 [ 0.68, 8.42 ]
Total (95% CI)
424
429
100.0 %
1.07 [ 0.59, 1.96 ]
0.1 0.2
0.5
10
26
Analysis 1.16. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 16 Admission to neonatal care unit.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 16 Admission to neonatal care unit
Study or subgroup
Treatment n/N
Control n/N 65/138 41/120 25/27 28/144
Weight
51/140 42/116 25/30 30/138
38.9 % 31.0 % 3.6 % 26.5 %
0.65 [ 0.40, 1.04 ] 1.09 [ 0.64, 1.86 ] 0.43 [ 0.09, 2.07 ] 1.15 [ 0.65, 2.05 ]
Total (95% CI)
424
429
100.0 %
0.87 [ 0.65, 1.17 ]
0.1 0.2
0.5
10
Analysis 1.17. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 17 Neonatal stay => 7days.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 17 Neonatal stay => 7days
Study or subgroup
Treatment n/N
Control n/N 30/138 21/120 11/27
Weight
Crowther 1989 Crowther 1990 Crowther 1991
25/140 14/116 17/30
49.9 % 33.8 % 16.3 %
0.78 [ 0.43, 1.41 ] 0.65 [ 0.32, 1.33 ] 1.87 [ 0.67, 5.24 ]
Total (95% CI)
286
285
100.0 %
0.85 [ 0.56, 1.29 ]
0.1 0.2
0.5
10
27
Analysis 1.19. Comparison 1 Hospitalisation for bed rest for women with a multiple pregnancy, Outcome 19 Development of maternal hypertension.
Comparison: 1 Hospitalisation for bed rest for women with a multiple pregnancy Outcome: 19 Development of maternal hypertension
Study or subgroup
Treatment n/N
Control n/N 6/69 9/60 3/9 9/45 13/72 5/107
Weight
7/70 3/58 1/10 3/32 9/69 4/105
18.7 % 17.1 % 5.2 % 15.7 % 29.5 % 13.7 %
1.17 [ 0.37, 3.63 ] 0.34 [ 0.10, 1.13 ] 0.26 [ 0.03, 2.27 ] 0.45 [ 0.13, 1.56 ] 0.69 [ 0.28, 1.70 ] 0.81 [ 0.21, 3.07 ]
Total (95% CI)
344
362
100.0 %
0.61 [ 0.37, 1.00 ]
0.1 0.2
0.5
10
Analysis 2.1. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 1 Perinatal death.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 1 Perinatal death
Study or subgroup
Treatment n/N
Control n/N 12/120 0/90 2/144 5/214
Weight
Crowther 1990 Hartikainen-Sorri Maclennan 1990 Saunders 1985
4/112 3/64 8/138 8/210
37.2 % 7.2 % 24.1 % 31.5 %
0.37 [ 0.13, 1.02 ] 11.45 [ 1.14, 115.52 ] 3.61 [ 1.02, 12.74 ] 1.64 [ 0.54, 4.94 ]
Total (95% CI)
524
568
100.0 %
1.31 [ 0.70, 2.43 ]
0.1 0.2
0.5
10
28
Analysis 2.2. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 2 Stillbirth.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 2 Stillbirth
Study or subgroup
Treatment n/N
Control n/N 11/120 0/90 1/144 3/214
Peto Odds Ratio Peto,Fixed,95% CI 0.24 [ 0.08, 0.74 ] 0.0 [ 0.0, 0.0 ] 4.06 [ 0.81, 20.42 ] 1.69 [ 0.42, 6.86 ]
2/116 0/64 5/138 5/210
Total (95% CI)

Total events: 12 (Treatment), 15 (Control)
528
568
0.82 [ 0.38, 1.77 ]
0.1 0.2
0.5
10
29
Analysis 2.3. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 3 Early neonatal death.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 3 Early neonatal death
Study or subgroup
Treatment n/N
Control n/N 1/120 0/90 1/144 2/214
Weight
2/116 3/64 3/138 3/210
20.1 % 19.5 % 26.8 % 33.6 %
2.03 [ 0.21, 19.69 ] 11.45 [ 1.14, 115.52 ] 2.87 [ 0.40, 20.60 ] 1.53 [ 0.26, 8.89 ]
Total (95% CI)
528
568
100.0 %
2.84 [ 1.02, 7.87 ]
0.1 0.2
0.5
10
Analysis 2.4. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 4 Gestational age at delivery.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 4 Gestational age at delivery
Study or subgroup
Treatment N Mean(SD) 58 32 69 105 36.1 (2) 36.7 (2.4) 35.1 (3.2) 37.3 (2.2)
Control N 60 45 72 107 Mean(SD) 35.9 (2.1) 37.4 (1.8) 35.7 (2.6) 37.9 (2.5)
Weight
28.4 % 16.1 % 16.7 % 38.8 %
0.20 [ -0.54, 0.94 ] -0.70 [ -1.68, 0.28 ] -0.60 [ -1.56, 0.36 ] -0.60 [ -1.23, 0.03 ]
Total (95% CI)
264
284
100.0 %
-0.39 [ -0.78, 0.01 ]
-10
-5
10
30
Analysis 2.5. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 5 Preterm delivery (< 37 weeks)
Study or subgroup
Treatment n/N
Control n/N 40/60 11/45 37/72 20/107
Weight
36/58 11/32 38/69 32/105
23.2 % 13.2 % 30.1 % 33.6 %
0.82 [ 0.39, 1.74 ] 1.62 [ 0.60, 4.38 ] 1.16 [ 0.60, 2.24 ] 1.88 [ 1.01, 3.52 ]
Total (95% CI)
264
284
100.0 %
1.31 [ 0.92, 1.89 ]
0.1 0.2
0.5
10
Analysis 2.6. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 6 Very preterm delivery (< 34 weeks)
Study or subgroup
Treatment n/N
Control n/N 11/60 10/72
Weight
Crowther 1990 Maclennan 1990
11/58 22/69
42.0 % 58.0 %
1.04 [ 0.41, 2.62 ] 2.77 [ 1.26, 6.07 ]
Total (95% CI)
127
132
100.0 %
1.84 [ 1.01, 3.34 ]
0.1 0.2
0.5
10
31
Analysis 2.7. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 7 Birthweight twinI/triplet I.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 7 Birthweight twinI/triplet I
Study or subgroup
Treatment N Mean(SD) 58 69 2.47 (0.49) 2.31 (0.67)
Control N 60 72 Mean(SD) 2.32 (0.39) 2.4 (0.6)
Weight
63.3 % 36.7 %
0.15 [ -0.01, 0.31 ] -0.09 [ -0.30, 0.12 ]
Total (95% CI)
127
132
100.0 %
0.06 [ -0.07, 0.19 ]
-10
-5
10
Analysis 2.8. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 8 Birthweight twinII/triplet II.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 8 Birthweight twinII/triplet II
Study or subgroup
Treatment N Mean(SD) 58 69 2.4 (0.45) 2.27 (0.73)
Control N 60 72 Mean(SD) 2.28 (0.47) 2.35 (0.56)
Weight
62.7 % 37.3 %
0.12 [ -0.05, 0.29 ] -0.08 [ -0.30, 0.14 ]
Total (95% CI)
127
132
100.0 %
0.05 [ -0.09, 0.18 ]
-10
-5
10
32
Analysis 2.9. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 9 Low birth weight (< 2500g).
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 9 Low birth weight (< 2500g)
Study or subgroup
Treatment n/N
Control n/N 77/120 27/90 84/144 92/214
Weight
68/116 22/64 74/138 76/210
21.6 % 12.6 % 26.8 % 39.1 %
0.79 [ 0.47, 1.34 ] 1.22 [ 0.62, 2.43 ] 0.83 [ 0.52, 1.32 ] 0.75 [ 0.51, 1.11 ]
Total (95% CI)
528
568
100.0 %
0.83 [ 0.65, 1.06 ]
0.1 0.2
0.5
10
Analysis 2.10. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 10 Very low birth weight (< 1500g).
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 10 Very low birth weight (< 1500g)
Study or subgroup
Treatment n/N
Control n/N 2/120 2/90 12/144 1/214
Weight
1/116 4/64 20/138 4/210
7.1 % 13.4 % 67.7 % 11.8 %
0.53 [ 0.05, 5.13 ] 2.91 [ 0.56, 15.17 ] 1.84 [ 0.88, 3.84 ] 3.42 [ 0.59, 19.93 ]
Total (95% CI)
528
568
100.0 %
1.93 [ 1.05, 3.53 ]
0.1 0.2
0.5
10
33
Analysis 2.11. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 11 Prelabour preterm rupture of the membranes
Study or subgroup
Treatment n/N
Control n/N 5/60 9/72
Weight
7/58 13/69
36.8 % 63.2 %
1.50 [ 0.46, 4.93 ] 1.61 [ 0.65, 3.99 ]
Total (95% CI)
127
132
100.0 %
1.57 [ 0.76, 3.23 ]
0.1 0.2
0.5
10
Analysis 2.12. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 12 Spontaneous onset of labour.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 12 Spontaneous onset of labour
Study or subgroup
Treatment n/N
Control n/N 56/60 60/72 101/107
Weight
Crowther 1990 Maclennan 1990 Saunders 1985
57/58 59/69 105/105
16.4 % 63.6 % 19.9 %
3.35 [ 0.56, 19.92 ] 1.18 [ 0.48, 2.92 ] 7.61 [ 1.51, 38.44 ]
Total (95% CI)
232
239
100.0 %
2.03 [ 0.98, 4.18 ]
0.1 0.2
0.5
10
34
Analysis 2.13. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 13 Caesarean delivery.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 13 Caesarean delivery
Study or subgroup
Treatment n/N
Control n/N 12/60 37/72
Weight
8/58 39/69
32.2 % 67.8 %
0.65 [ 0.25, 1.68 ] 1.23 [ 0.63, 2.38 ]
Total (95% CI)
127
132
100.0 %
1.00 [ 0.58, 1.72 ]
0.1 0.2
0.5
10
Analysis 2.14. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 14 Apgar score < 7 at 1 minute
Study or subgroup
Treatment n/N
Control n/N 36/210 10/90 50/144 21/214
Weight
22/116 10/64 42/138 24/210
26.8 % 10.4 % 38.1 % 24.7 %
1.13 [ 0.63, 2.05 ] 1.49 [ 0.57, 3.85 ] 0.82 [ 0.50, 1.35 ] 1.19 [ 0.64, 2.20 ]
Total (95% CI)
528
658
100.0 %
1.04 [ 0.77, 1.42 ]
0.1 0.2
0.5
10
35
Analysis 2.15. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 15 Apgar score < 7 at 5 minutes
Study or subgroup
Treatment n/N
Control n/N 15/120 3/144
Weight
7/116 7/138
67.4 % 32.6 %
0.47 [ 0.19, 1.12 ] 2.39 [ 0.68, 8.42 ]
Total (95% CI)
254
264
100.0 %
0.79 [ 0.39, 1.63 ]
0.1 0.2
0.5
10
Analysis 2.16. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 16 Admission to neonatal care unit.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 16 Admission to neonatal care unit
Study or subgroup
Treatment n/N
Control n/N 41/120 28/144
Weight
42/116 30/138
53.9 % 46.1 %
1.09 [ 0.64, 1.86 ] 1.15 [ 0.65, 2.05 ]
Total (95% CI)
254
264
100.0 %
1.12 [ 0.76, 1.66 ]
0.1 0.2
0.5
10
36
Analysis 2.17. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 17 Neonatal stay => 7days.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 17 Neonatal stay => 7days
Study or subgroup
Treatment n/N
Control n/N 21/120
Weight
Crowther 1990
14/116
100.0 %
0.65 [ 0.32, 1.33 ]
Total (95% CI)

Heterogeneity: not applicable
116
120
100.0 %
0.65 [ 0.32, 1.33 ]
Total events: 14 (Treatment), 21 (Control) Test for overall effect: Z = 1.17 (P = 0.24)
0.1 0.2
0.5
10
Analysis 2.19. Comparison 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy, Outcome 19 Development of maternal hypertension.
Comparison: 2 Hospitalisation for bed rest for women with an uncomplicated twin pregnancy Outcome: 19 Development of maternal hypertension
Study or subgroup
Treatment n/N
Control n/N 9/60 9/45 13/72 5/107
Weight
3/58 3/32 9/69 4/105
22.6 % 20.7 % 38.8 % 18.0 %
0.34 [ 0.10, 1.13 ] 0.45 [ 0.13, 1.56 ] 0.69 [ 0.28, 1.70 ] 0.81 [ 0.21, 3.07 ]
Total (95% CI)
264
284
100.0 %
0.55 [ 0.32, 0.97 ]
0.1 0.2
0.5
10
37
Analysis 3.1. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 1 Perinatal death.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 1 Perinatal death
Study or subgroup
Treatment n/N
Control n/N 3/27
Weight
Crowther 1991
1/30
100.0 %
0.31 [ 0.04, 2.33 ]
Total (95% CI)

30
27
100.0 %
0.31 [ 0.04, 2.33 ]
0.1 0.2
0.5
10
Analysis 3.2. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 2 Stillbirth.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 2 Stillbirth
Study or subgroup
Treatment n/N
Control n/N 0/27
Weight
Crowther 1991
1/30
100.0 %
6.69 [ 0.13, 338.79 ]
Total (95% CI)

30
27
100.0 %
6.69 [ 0.13, 338.79 ]
0.1 0.2
0.5
10
38
Analysis 3.3. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 3 Early neonatal death.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 3 Early neonatal death
Study or subgroup
Treatment n/N
Control n/N 2/27
Weight
Crowther 1991
0/30
100.0 %
0.12 [ 0.01, 1.92 ]
Total (95% CI)

30
27
100.0 %
0.12 [ 0.01, 1.92 ]
0.1 0.2
0.5
10
Analysis 3.4. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 4 Gestational age at delivery.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 4 Gestational age at delivery
Study or subgroup
Treatment N Mean(SD) 10 34.4 (2.2)
Control N 9 Mean(SD) 33.7 (2.5)
Weight
Crowther 1991
100.0 %
0.70 [ -1.43, 2.83 ]
Total (95% CI)

10
100.0 %
0.70 [ -1.43, 2.83 ]
Test for overall effect: Z = 0.64 (P = 0.52)
-10
-5
10
39
Analysis 3.5. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 5 Preterm delivery (< 37 weeks)
Study or subgroup
Treatment n/N
Control n/N 9/9
Weight
Crowther 1991
8/10
100.0 %
0.13 [ 0.01, 2.33 ]
Total (95% CI)

10
100.0 %
0.13 [ 0.01, 2.33 ]
0.1 0.2
0.5
10
Analysis 3.6. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 6 Very preterm delivery (< 34 weeks)
Study or subgroup
Treatment n/N
Control n/N 4/9
Weight
Crowther 1991
3/10
100.0 %
0.56 [ 0.09, 3.42 ]
Total (95% CI)

10
100.0 %
0.56 [ 0.09, 3.42 ]
0.1 0.2
0.5
10
40
Analysis 3.7. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 7 Birthweight triplet I.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 7 Birthweight triplet I
Study or subgroup
Weight
Crowther 1991
100.0 %
0.17 [ -0.23, 0.57 ]
Total (95% CI)

10
100.0 %
0.17 [ -0.23, 0.57 ]
-10
-5
10
Analysis 3.8. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 8 Birthweight triplet II.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 8 Birthweight triplet II
Study or subgroup
Weight
Crowther 1991
100.0 %
0.04 [ -0.19, 0.27 ]
Total (95% CI)

10
100.0 %
0.04 [ -0.19, 0.27 ]
-10
-5
10
41
Analysis 3.9. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 9 Birthweight triplet III.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 9 Birthweight triplet III
Study or subgroup
Weight
Crowther 1991
100.0 %
0.32 [ -0.13, 0.77 ]
Total (95% CI)

10
100.0 %
0.32 [ -0.13, 0.77 ]
-10
-5
10
Analysis 3.10. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 10 Low birth weight (< 2500g).
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 10 Low birth weight (< 2500g)
Study or subgroup
Treatment n/N
Control n/N 27/27
Weight
Crowther 1991
26/30
100.0 %
0.13 [ 0.02, 1.01 ]
Total (95% CI)

30
27
100.0 %
0.13 [ 0.02, 1.01 ]
0.1 0.2
0.5
10
42
Analysis 3.11. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 11 Very low birth weight (< 1500g).
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 11 Very low birth weight (< 1500g)
Study or subgroup
Treatment n/N
Control n/N 6/27
Weight
Crowther 1991
4/30
100.0 %
0.55 [ 0.14, 2.12 ]
Total (95% CI)

30
27
100.0 %
0.55 [ 0.14, 2.12 ]
0.1 0.2
0.5
10
Analysis 3.12. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 12 Prelabour preterm rupture of the membranes.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 12 Prelabour preterm rupture of the membranes
Study or subgroup
Treatment n/N
Control n/N 3/9
Weight
Crowther 1991
1/10
100.0 %
0.26 [ 0.03, 2.27 ]
Total (95% CI)

10
100.0 %
0.26 [ 0.03, 2.27 ]
0.1 0.2
0.5
10
43
Analysis 3.13. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 13 Spontaneous onset of labour.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 13 Spontaneous onset of labour
Study or subgroup
Treatment n/N
Control n/N 9/9
Peto Odds Ratio Peto,Fixed,95% CI 0.0 [ 0.0, 0.0 ]
Crowther 1991
10/10
Total (95% CI)

Total events: 10 (Treatment), 9 (Control) Heterogeneity: not applicable Test for overall effect: Z = 0.0 (P < 0.00001)
10
0.0 [ 0.0, 0.0 ]
0.1 0.2
0.5
10
Analysis 3.14. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 14 Caesarean delivery.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 14 Caesarean delivery
Study or subgroup
Treatment n/N
Control n/N 0/9
Weight
Crowther 1991
2/10
100.0 %
7.48 [ 0.43, 130.05 ]
Total (95% CI)

10
100.0 %
7.48 [ 0.43, 130.05 ]
0.1 0.2
0.5
10
44
Analysis 3.15. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 15 Apgar score < 7 at 1 minute.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 15 Apgar score < 7 at 1 minute
Study or subgroup
Treatment n/N
Control n/N 8/27
Weight
Crowther 1991
5/30
100.0 %
0.49 [ 0.14, 1.66 ]
Total (95% CI)

30
27
100.0 %
0.49 [ 0.14, 1.66 ]
0.1 0.2
0.5
10
Analysis 3.16. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 16 Apgar score < 7 at 5 minutes.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 16 Apgar score < 7 at 5 minutes
Study or subgroup
Treatment n/N
Control n/N 0/27
Weight
Crowther 1991
1/30
100.0 %
6.69 [ 0.13, 338.79 ]
Total (95% CI)

30
27
100.0 %
6.69 [ 0.13, 338.79 ]
0.1 0.2
0.5
10
45
Analysis 3.17. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 17 Admission to neonatal care unit.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 17 Admission to neonatal care unit
Study or subgroup
Treatment n/N
Control n/N 25/27
Weight
Crowther 1991
25/30
100.0 %
0.43 [ 0.09, 2.07 ]
Total (95% CI)

30
27
100.0 %
0.43 [ 0.09, 2.07 ]
0.1 0.2
0.5
10
Analysis 3.18. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 18 Neonatal stay => 7days.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 18 Neonatal stay => 7days
Study or subgroup
Treatment n/N
Control n/N 11/27
Weight
Crowther 1991
17/30
100.0 %
1.87 [ 0.67, 5.24 ]
Total (95% CI)

30
27
100.0 %
1.87 [ 0.67, 5.24 ]
0.1 0.2
0.5
10
46
Analysis 3.20. Comparison 3 Hospitalisation for bed rest for women with a triplet pregnancy, Outcome 20 Development of maternal hypertension.
Comparison: 3 Hospitalisation for bed rest for women with a triplet pregnancy Outcome: 20 Development of maternal hypertension
Study or subgroup
Treatment n/N
Control n/N 3/9
Weight
Crowther 1991
1/10
100.0 %
0.26 [ 0.03, 2.27 ]
Total (95% CI)

10
100.0 %
0.26 [ 0.03, 2.27 ]
0.1 0.2
0.5
10
Analysis 4.1. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 1 Perinatal death.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 1 Perinatal death
Study or subgroup
Treatment n/N
Control n/N 2/138
Weight
Crowther 1989
2/140
100.0 %
0.99 [ 0.14, 7.07 ]
Total (95% CI)

140
138
100.0 %
0.99 [ 0.14, 7.07 ]
0.1 0.2
0.5
10
47
Analysis 4.2. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 2 Stillbirth.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 2 Stillbirth
Study or subgroup
Treatment n/N
Control n/N 1/138
Weight
Crowther 1989
1/140
100.0 %
0.99 [ 0.06, 15.84 ]
Total (95% CI)

140
138
100.0 %
0.99 [ 0.06, 15.84 ]
0.1 0.2
0.5
10
Analysis 4.3. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 3 Early neonatal death.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 3 Early neonatal death
Study or subgroup
Treatment n/N
Control n/N 1/138
Weight
Crowther 1989
1/140
100.0 %
0.99 [ 0.06, 15.84 ]
Total (95% CI)

140
138
100.0 %
0.99 [ 0.06, 15.84 ]
0.1 0.2
0.5
10
48
Analysis 4.4. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 4 Gestational age at delivery.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 4 Gestational age at delivery
Study or subgroup
Weight
Crowther 1989
100.0 %
0.0 [ -0.63, 0.63 ]
Total (95% CI)

70
69
100.0 %
0.0 [ -0.63, 0.63 ]
-10
-5
10
Analysis 4.5. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 5 Preterm delivery (< 37 weeks).
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 5 Preterm delivery (< 37 weeks)
Study or subgroup
Treatment n/N
Control n/N 55/69
Weight
Crowther 1989
51/70
100.0 %
0.69 [ 0.32, 1.50 ]
Total (95% CI)

70
69
100.0 %
0.69 [ 0.32, 1.50 ]
0.1 0.2
0.5
10
49
Analysis 4.6. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 6 Very preterm delivery (< 34 weeks).
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 6 Very preterm delivery (< 34 weeks)
Study or subgroup
Treatment n/N
Control n/N 12/69
Weight
Crowther 1989
11/70
100.0 %
0.89 [ 0.36, 2.16 ]
Total (95% CI)

70
69
100.0 %
0.89 [ 0.36, 2.16 ]
0.1 0.2
0.5
10
Analysis 4.7. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 7 Birthweight twin I.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 7 Birthweight twin I
Study or subgroup
Weight
Crowther 1989
100.0 %
0.10 [ -0.06, 0.26 ]
Total (95% CI)

70
69
100.0 %
0.10 [ -0.06, 0.26 ]
-10
-5
10
50
Analysis 4.8. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 8 Birthweight twin II.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 8 Birthweight twin II
Study or subgroup
Weight
Crowther 1989
100.0 %
0.13 [ -0.02, 0.28 ]
Total (95% CI)

70
69
100.0 %
0.13 [ -0.02, 0.28 ]
-10
-5
10
Analysis 4.9. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 9 Low birth weight (< 2500g).
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 9 Low birth weight (< 2500g)
Study or subgroup
Treatment n/N
Control n/N 86/138
Weight
Crowther 1989
84/140
100.0 %
0.91 [ 0.56, 1.47 ]
Total (95% CI)

140
138
100.0 %
0.91 [ 0.56, 1.47 ]
0.1 0.2
0.5
10
51
Analysis 4.10. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 10 Very low birth weight (< 1500g).
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 10 Very low birth weight (< 1500g)
Study or subgroup
Treatment n/N
Control n/N 6/138
Weight
Crowther 1989
4/140
100.0 %
0.65 [ 0.18, 2.30 ]
Total (95% CI)

140
138
100.0 %
0.65 [ 0.18, 2.30 ]
0.1 0.2
0.5
10
Analysis 4.11. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 11 Prelabour preterm rupture of the membranes.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 11 Prelabour preterm rupture of the membranes
Study or subgroup
Treatment n/N
Control n/N 8/69
Weight
Crowther 1989
13/70
100.0 %
1.72 [ 0.68, 4.33 ]
Total (95% CI)

70
69
100.0 %
1.72 [ 0.68, 4.33 ]
0.1 0.2
0.5
10
52
Analysis 4.12. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 12 Spontaneous onset of labour.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 12 Spontaneous onset of labour
Study or subgroup
Treatment n/N
Control n/N 65/69
Weight
Crowther 1989
69/70
100.0 %
3.49 [ 0.59, 20.69 ]
Total (95% CI)

70
69
100.0 %
3.49 [ 0.59, 20.69 ]
0.1 0.2
0.5
10
Analysis 4.13. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 13 Caesarean delivery.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 13 Caesarean delivery
Study or subgroup
Treatment n/N
Control n/N 10/69
Weight
Crowther 1989
5/70
100.0 %
0.47 [ 0.16, 1.36 ]
Total (95% CI)

70
69
100.0 %
0.47 [ 0.16, 1.36 ]
0.1 0.2
0.5
10
53
Analysis 4.14. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 14 Apgar score < 7 at 1 minute.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 14 Apgar score < 7 at 1 minute
Study or subgroup
Treatment n/N
Control n/N 29/138
Weight
Crowther 1989
21/140
100.0 %
0.67 [ 0.36, 1.23 ]
Total (95% CI)

140
138
100.0 %
0.67 [ 0.36, 1.23 ]
0.1 0.2
0.5
10
Analysis 4.15. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 15 Apgar score < 7 at 5 minutes.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 15 Apgar score < 7 at 5 minutes
Study or subgroup
Treatment n/N
Control n/N 4/138
Weight
Crowther 1989
8/140
100.0 %
1.97 [ 0.62, 6.26 ]
Total (95% CI)

140
138
100.0 %
1.97 [ 0.62, 6.26 ]
0.1 0.2
0.5
10
54
Analysis 4.16. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 16 Admission to neonatal care unit.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 16 Admission to neonatal care unit
Study or subgroup
Treatment n/N
Control n/N 65/138
Weight
Crowther 1989
51/140
100.0 %
0.65 [ 0.40, 1.04 ]
Total (95% CI)

140
138
100.0 %
0.65 [ 0.40, 1.04 ]
0.1 0.2
0.5
10
Analysis 4.17. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 17 Neonatal stay => 7days.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 17 Neonatal stay => 7days
Study or subgroup
Treatment n/N
Control n/N 30/138
Weight
Crowther 1989
25/140
100.0 %
0.78 [ 0.43, 1.41 ]
Total (95% CI)

140
138
100.0 %
0.78 [ 0.43, 1.41 ]
0.1 0.2
0.5
10
55
Analysis 4.19. Comparison 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy, Outcome 19 Development of maternal hypertension.
Comparison: 4 Hospitalisation for bed rest for women with cervical dilatation in a twin pregnancy Outcome: 19 Development of maternal hypertension
Study or subgroup
Treatment n/N
Control n/N 6/69
Weight
Crowther 1989
7/70
100.0 %
1.17 [ 0.37, 3.63 ]
Total (95% CI)

70
69
100.0 %
1.17 [ 0.37, 3.63 ]
0.1 0.2
0.5
10
WHATS NEW
Last assessed as up-to-date: 30 September 2000.
10 November 2008 3 September 2008
Amended Amended
Contact details edited. Converted to new review format.
HISTORY
Protocol rst published: Issue 3, 1997 Review rst published: Issue 3, 1997
19 August 2000
New search has been performed
Search updated. 4 new trials found.
56
CONTRIBUTIONS OF AUTHORS
A single reviewer contributed to the development of the protocol, identication and selection of studies for inclusion, data extraction and preparation of the text of the review.
DECLARATIONS OF INTEREST
The reviewer was chief investigator on three of the trials included in this review.
SOURCES OF SUPPORT Internal sources

Department of Obstetrics and Gynaecology, University of Adelaide, Australia.
External sources
No sources of support supplied
INDEX TERMS Medical Subject Headings (MeSH)

Bed
Rest; Hospitalization; Pregnancy, Multiple; Pregnancy Outcome; Randomized Controlled Trials as Topic
MeSH check words

Female; Humans; Pregnancy
57

Hospitalisation and Bed Rest For Multiple Pregnancy (Review)

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Hospitalisation and Bed Rest For Multiple Pregnancy (Review)

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Hospitalisation and bed rest for multiple pregnancy (Review)

Hospitalisation and bed rest for multiple pregnancy

Search methods for identication of studies

Data collection and analysis

Criteria for considering studies for this review

Risk of bias in included studies

AUTHORS CONCLUSIONS Implications for practice

Implications for research

References to studies included in this review

References to studies excluded from this review

References to other published versions of this review

References to studies awaiting assessment

Characteristics of included studies [ordered by study ID]

Notes Risk of bias Item Allocation concealment?

Authors judgement Yes

Risk of bias Item Allocation concealment? Authors judgement No Description C - Inadequate

Notes Risk of bias Item Allocation concealment?

Authors judgement Yes

Characteristics of excluded studies [ordered by study ID]

DATA AND ANALYSES

Control n/N 2/138 12/120 3/27 0/90 2/144 5/214

Peto Odds Ratio Peto,Fixed,95% CI

Peto Odds Ratio Peto,Fixed,95% CI

2/140 4/112 1/30 3/64 8/138 8/210

8.3 % 31.2 % 7.9 % 6.0 % 20.2 % 26.4 %

Total (95% CI)

1.14 [ 0.65, 2.01 ]

Control n/N 1/138 11/120 0/27 0/90 1/144 3/214

Peto Odds Ratio Peto,Fixed,95% CI

1/140 2/116 1/30 0/64 5/138 5/210

Total (95% CI)

0.89 [ 0.43, 1.85 ]

Control n/N 1/138 1/120 2/27 0/90 1/144 2/214

Peto Odds Ratio Peto,Fixed,95% CI

Peto Odds Ratio Peto,Fixed,95% CI

1/140 2/116 0/30 3/64 3/138 3/210

10.7 % 15.9 % 10.5 % 15.4 % 21.1 % 26.5 %

Total (95% CI)

1.81 [ 0.73, 4.49 ]

Mean Difference IV,Fixed,95% CI

Mean Difference IV,Fixed,95% CI

27.4 % 20.0 % 2.4 % 11.3 % 11.7 % 27.2 %

Total (95% CI)

-0.26 [ -0.59, 0.07 ]

Control n/N 55/69 40/60 9/9 11/45 37/72 20/107

Peto Odds Ratio Peto,Fixed,95% CI

Peto Odds Ratio Peto,Fixed,95% CI

51/70 36/58 8/10 11/32 38/69 32/105

17.5 % 18.8 % 1.3 % 10.7 % 24.4 % 27.2 %

Total (95% CI)

1.14 [ 0.82, 1.58 ]

Control n/N 12/69 11/60 4/9 10/72

Peto Odds Ratio Peto,Fixed,95% CI

Peto Odds Ratio Peto,Fixed,95% CI

Crowther 1989 Crowther 1990 Crowther 1991 Maclennan 1990

11/70 11/58 3/10 22/69

28.9 % 27.0 % 7.0 % 37.2 %

Total (95% CI)

1.37 [ 0.85, 2.21 ]

Mean Difference IV,Fixed,95% CI

Mean Difference IV,Fixed,95% CI

Crowther 1989 Crowther 1990 Crowther 1991 Maclennan 1990