The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy

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Abstract
Objective: To test whether a policy of hospitalization for bed rest, from 28-30 weeks gestation until delivery, lengthens the duration of gestation, improves fetal growth and decreases neonatal morbidity in twin pregnancy. Design: A randomized controlled trial. Setting: Harare Maternity Hospital, Zimbabwe. Subjects: 118 women with an uncomplicated twin pregnancy between 28 and 30 weeks gestation. Intervention: Hospitalization for bed rest. Encouraged to rest in bed as much as possible, although voluntary ambulation was allowed. Main outcome measures: Gestational age at delivery and number of infants delivered preterm (< 37 weeks); birthweight and number of small-for-gestational age (SGA) infants; neonatal morbidity was assessed by number of infants requiring admission to the neonatal unit and the length of stay. Results: There was no effect on duration of gestation or the occurrence of preterm delivery. Mean birthweight was greater in the hospitalized group (t = -2.28, df 234, P = 0.02) and there were fewer SGA infants (OR 0.57, 95% CI 0.33-0.96). No differences were found in neonatal morbidity. Conclusions: Hospitalization for bed rest does not prolonged pregnancy but can improve fetal growth, although this was not reflected in improved neonatal morbidity. Whether twin fetal growth can be enhanced similarly in other populations should be investigated.

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