A Comparison of Bed Rest Versus Moderate Activity in Preterm Premature Rupture of Membranes (PPROM) (PACT)

A Comparison of Bed Rest Versus Moderate Activity Among Inpatient Antepartum Patients With Preterm Premature Rupture of Membranes (PPROM): A Randomized Controlled Trial

University of California, San Francisco, University of California, Davis, University of California, Irvine, University of California, Los Angeles

Bed rest has been a commonly prescribed intervention for high risk pregnancies, despite the lack of data to support its benefits, and increasing evidence pointing to potential harms. In this study, the effects of bed rest compared to moderate activity will be on maternal mood and muscle strength will be evaluated in patients with preterm premature rupture of membranes (PPROM).

Historically, bed rest has been considered a beneficial treatment option for patients with high risk pregnancies. The definition of bed rest varies between providers, and can mean anything from being completely bed-bound for months at a time (sometimes called strict bed rest) to walking around within the home a few times a day (sometimes called modified bed rest). Recent studies have highlighted potential harmful effects from bed rest. However, scientific studies need to be carried out to compare the effects of bed rest and moderate activity on the health of mothers and babies. PPROM is defined as rupture of membranes prior to 37 weeks gestation prior to the onset of labor, and affects approximately 3% of all pregnancies in the Unites States. Women with PPROM are routinely managed in the inpatient setting from the time of diagnosis until delivery. Therefore, PPROM patients are a closely supervised and easily accessible cohort of women. In this study, participating patients with PPROM will be randomized into two groups: bedrest or moderate activity. Maternal mood and muscle strength will be assessed at enrollment and after delivery to determine whether there are significant differences in these outcomes in the two groups.

Bedrest is a standard recommendation for patients with PPROM. Subjects randomized to this arm of the study will undergo the following: Receive recommendation for bedrest (standard of care). Have maternal mood and muscle strength evaluated on enrollment and after delivery (observational study procedure). Wear a pedometer to measure activity when out of bed (observational study procedure).

Subjects randomized to this arm of the study will undergo the following: Receive recommendation to ambulate 150 feet, twice per day (interventional study procedure). Prior to each session of ambulation, an ultrasound will be performed to ensure adequate amniotic fluid volume and appropriate fetal position, and a fetal heart rate tracing will be obtained to ensure that there is reassuring fetal status (observational study procedure). During each session of ambulation, the fetal heart rate tracing will be monitored continuously (observational study procedure). Have maternal mood and muscle strength evaluated on enrollment and after delivery (observational study procedure). Wear a pedometer to measure activity when out of bed (observational study procedure).

Maternal Depression Score as measured by the Edinburg Postpartum Depression Scale will be determined at the time of enrollment and after delivery.

Maternal Anxiety Score as measured by the State-Trait Anxiety Inventory will be determined at the time of enrollment and after delivery.

Maternal Muscle Strength as measured by semi-quantitative muscle strength testinging will be determined at the time of enrollment and after delivery.

Inclusion Criteria: Pregnant Gestational age between 23 weeks 0 days - 32 weeks 0 days Diagnosed with preterm premature rupture of membranes Exclusion Criteria: Cervical dilation greater than or equal to 3cm Active labor Evidence of infection Inability to provide informed consent Requirement for continuous fetal monitoring

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