Bed Rest in Pregnancy: When is it Necessary?

Question
Under what circumstances is bed rest called for?  For a woman 32 years of age in a low risk first pregnancy of a single foetus (no previous miscarriages), does a shortened cervix (half the normal size) discovered at 26 weeks (from the first day of last period) or the fact that the baby is lying very low in the uterus close to the cervix justify strict bed rest til the end of the pregnancy?  Thanks.  

Answer
At 26 weeks gestation, the cervical length should be longer than 3cm.  If it is less than 3cm, there is a risk of preterm labor. Therefore, I would agree with bedrest and restriction of sexual activity, heavy lifting, and straining. Certainly, if there is any evidence of contractions, prophylactic tocolysis should be considered. At a minimum, if the cervix is shortened at this time, serial sonography should be done to see if there is any further shortening.  In the literature, it has been found that bedrest does not alter the course of preterm labor, but clinically, we still recommend bedrest because it appears to help.