Do I need to be on bedrest at 36 weeks pregnant with preeclampsia?

Management of Preeclampsia at 36 Weeks Pregnancy: Bedrest Not Recommended

Bedrest is not recommended as a management strategy for preeclampsia at 36 weeks of pregnancy. Instead, immediate delivery is the recommended approach for women with preeclampsia at ≥37 weeks gestation, and delivery is generally recommended for women with preeclampsia at 34-37 weeks gestation 1.

Assessment and Management of Preeclampsia at 36 Weeks

Initial Assessment

When diagnosed with preeclampsia at 36 weeks, you should undergo:

• Blood pressure monitoring
• Proteinuria assessment
• Clinical assessment for symptoms (headache, visual disturbances, epigastric pain)
• Laboratory tests including:
  • Complete blood count with platelets
  • Liver function tests
  • Renal function
  • Uric acid 1

Management Approach

1. Delivery Considerations:

   • At 36 weeks with preeclampsia, delivery is generally recommended rather than expectant management 1
   • The decision between immediate delivery and short-term expectant management depends on:
     • Severity of preeclampsia
     • Maternal condition
     • Fetal status 1

2. Blood Pressure Management:

   • If blood pressure is severe (>160/110 mmHg), urgent treatment in a monitored setting is required
   • First-line medications include oral nifedipine or intravenous labetalol or hydralazine
   • Target blood pressure: diastolic 85 mmHg, systolic 110-140 mmHg 1

3. Seizure Prevention:

   • Magnesium sulfate is indicated for women with preeclampsia who have:
     • Proteinuria and severe hypertension
     • Hypertension with neurological signs/symptoms 1

Why Bedrest Is Not Recommended

The current evidence and guidelines do not support bedrest as a management strategy for preeclampsia at 36 weeks. Instead, the focus is on:

1. Close Monitoring: Regular assessment of maternal and fetal well-being 1

2. Delivery Planning: At 36 weeks, delivery is generally the recommended approach rather than prolonging the pregnancy with interventions like bedrest 1

3. Hospital-Based Care: For severe preeclampsia, in-hospital management is recommended rather than home-based bedrest 1

Important Considerations

• Warning Signs: Be aware of symptoms requiring immediate medical attention:

  • Severe headache
  • Visual disturbances
  • Epigastric pain
  • Shortness of breath
  • Decreased fetal movement 2, 1

• Post-Delivery Care:

  • Blood pressure monitoring should continue every 4-6 hours for at least 3 days
  • Antihypertensive medications should be tapered slowly after days 3-6
  • Follow-up within 1 week if still on antihypertensives at discharge 1

• Long-term Implications: Women who have had preeclampsia have increased risks of cardiovascular disease later in life, requiring ongoing follow-up 3

Common Pitfalls to Avoid

1. Assuming Bedrest Helps: Despite traditional practices, there is no evidence that bedrest improves outcomes in preeclampsia at 36 weeks

2. Delaying Delivery: At 36 weeks with preeclampsia, prolonging pregnancy may increase maternal and fetal risks without significant benefit 1

3. Inadequate Monitoring: Even without bedrest, close monitoring of maternal and fetal conditions is essential until delivery 2, 1

4. Missing Warning Signs: Failure to recognize and respond to symptoms of worsening preeclampsia can lead to serious complications 1

In conclusion, at 36 weeks of pregnancy with preeclampsia, the focus should be on appropriate medical management and timely delivery rather than bedrest. Close monitoring and prompt intervention for concerning symptoms are essential components of care.