SMFM Consult Series #50: The role of activity restriction in obstetric management

Despite current recommendations against its use, activity restriction remains a common intervention used
to prevent preterm birth in multiple clinical settings. Hypertensive disorders of pregnancy, preterm premature
rupture ofmembranes,multiple gestations, vaginal bleeding, short cervical length, placenta previa,
and fetal growth restriction are also common reasons for antepartum hospital admission and frequently
lead to a recommendation for activity restriction. However, numerous reports have shown that activity
restriction does not prevent adverse obstetrical outcomes but does confer significant physical and psychosocial
risks. This consult reviews the current literature on activity restriction and examines the evidence
regarding its use in obstetrical management. The recommendations by the Society for Maternal-Fetal
Medicine are as follows: (1) we recommend against the routine use of any type of activity restriction in
pregnant women at risk of preterm birth based on preterm labor symptoms, arrested preterm labor, or
shortened cervix (GRADE 1B); (2) we recommend against the use of routine inpatient hospitalization and
activity restriction for the prevention of pretermbirth inwomen withmultiple gestations (GRADE1A); and (3)
given the lack of data definitively demonstrating that activity restriction improves perinatal outcome in
pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive
diseases of pregnancy, coupled with evidence of adverse effects of activity restriction, we
suggest that activity restriction not be prescribed for the treatment of pregnancies complicated by fetal
growth restriction, preterm premature rupture of membranes, or hypertensive disease (GRADE 2B).