zvrk wrote:
mozete li argumentovati stav da od lezanja nema koristi posto ne znam da se iko normalan moze dobro osjecati ako lezi 70 dana...ali ako ljekar naredi - sto se mora, mora se.
hvala unaprijed
Williams Obstetrics, cijenjeni američki udžbenik porodiljstva, 23. izdanje (2010.)
Poglavlje o spontanom pobačaju (str. 221):
There are no effective therapies for threatened abortion. Bed rest, although often prescribed, does not alter its course.
A potom se, u poglavlju o prijevremenom porodu, navodi čitav niz studija, od kojih nijedna nije ustanovila koristi od ležanja radi spriječavanja prijevremenog poroda, ali dvije jesu našle komplikacije takvog postupka. Citiraću taj dio u cjelosti (str. 823):
Bed Rest
This is one of the most often prescribed interventions during pregnancy, yet one of the least studied. In 1994, Goldenberg and colleagues reviewed the available literature on bed rest in pregnancy and concluded that they could find no evidence supporting or refuting the benefit of either bed rest or hospitalization in women threatening preterm delivery. More recently, Sosa and associates (2004) searched the Cochrane Database for randomized trials done to assess the efficacy of bed rest at home or with hospitalization. They concluded that the available evidence neither supported nor refuted the use of bed rest to prevent preterm birth. Goulet and colleagues (2001) randomized 250 Canadian women to either home care or hospitalization after treatment of an acute episode of preterm labor and also found no benefits.
Yost and colleagues (2005) attempted a randomized study at Parkland Hospital but terminated the study after 6 years due to low recruitment. In this study, bed rest in the hospital compared with bed rest at home had no effect on pregnancy duration in women with threatened preterm labor before 34 weeks. Bed rest was not enforced—that is, women were permitted ambulation ad lib either in the hospital or at home.
Kovacevich and associates (2000) reported that bed rest for 3 days or more increased thromboembolic complications to 16 per 1000 women com-pared with only 1 per 1000 with normal ambulation. Promislow and co-workers (2004) observed significant bone loss in pregnant women prescribed outpatient bed rest.
Na sajtu The Fetal Medical Fondation, velike fondacije koju je osnovao K.Nicolaides (da bi ste shvatile njegov značaj, da kažem da je čovjek uveo, između ostalog, mjerenje nuhalnog nabora za procjenu rizika za trisomije, što je danas neizostavni dio kontrole trudnoće), a koja se bavi i edukacijom ginekologa iz ultrazvuka, jasno stoji:
No benefit in reducing the risk of recurrence (misli se na ponavljanje prijevremenog poroda kod žena koje su ga već imale-op.jsg) has been shown for the following strategies:
Bed rest in hospital or at home is widely recommended for the prevention of preterm birth but there is no scientific evidence to support this practice. Indeed, randomized studies in twin pregnancies showed that bed rest increases the risk of preterm delivery. Bed rest may also have some adverse effects for women, including increased likelihood of venous thrombosis, muscle atrophy and stress.
Betamimetics given prophylactically.
Life style interventions, such as decrease in manual labor, increase in visits to antenatal clinics, psychological support, or diet supplementation with iron, folate, calcium, zinc magnesium, vitamins, or fish oil.
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Mene svi ubjedjuju kako moram i kod anesteziologa, a ja govorim da mi to nigdje ne pise, a i pitala sam i dr opce prakse, i ginekologa i one u komisiji...
)