Kate Hooks
A
Common Consultation
 AIMS:
 To
distinguish rashes which may have
complications from those which do not.
 To develop a management strategy
 Some understanding of other skin rashes in
pregnancy.
 Detailed
hx/bloods at booking
 All women advised to contact GP or Midwife
urgently if they are in contact with or
develop a rash.
 Common
illness
 Highly contagious- 90% of adults are immune
 Complicates 3/1000 pregnancies
 Incubation- 14-21 days- infectious from 2
days before the rash until crusting
 Features- Fever, Rashpapules/vesicles/centripetal/itchy/mucus
membranes
Risk to Mother
10% risk of pneumonia- inc with gestation
Mortality 1/1000 infections
Refer if rash worsening for >6 days
Admit:
Chest symptoms
Neurological symptoms
Haemorrhagic rash
Immunosuppressed
Risk- term, smoker, poor social circumstances
Risk to Foetus/Newborn
Gestation- <28wks 5-10%
>30wks 50%
Presentation <20wks- ^Miscarriage
1-2% FVS
20-37wks – risk of FVS rare
Baby especially vulnerable 4 days before to 2
days after delivery- 20% risk of overwhelming
neonatal infection- SPECIALIST ADVICE
Management
 Mother clear hx of chickenpox- reassure
 Not- Send Serum Specific IgG- positive –
reassure
 Negative- VZ-IgG- if less than 10 days from
exposure- and close monitoring.
 Vaccination-
rare
 1-2% adult women are susceptible
 Reinfection can occur in those vaccinated
 Incubation- 14-21
 Infectious- 7 days before-10 days after rash.
 Fever, lymphadenopathy and pink
maculopapular rash
 Risk
to Foetus
 <11wks- 90% risk transmission- 90% adverse
outcome risk
 11-16wks- 55% risk transmission- 20% adverse
outcome risk
 >16wks- 45% risk transmission- risk deafness
only
 >20wks- foetal development not affected
Management
 Non vesicular rash- check for rubella
antibodies or reassure only if immunisation
x2. Also check Parvovirus B19.
 IgG- reassure
 No antibodies- send another sample 1 month
after contact
 IgM- Confirm- inform mother result and
implications
 Risk
infection in pregnancy 1/400
 50% young women not immune
 50% risk of child fifths disease- non immune
mother.
 Inc- 13-18 days- infectious from 10 days
before the rash appears to the onset.
 Fever, arthritis, lace like rash trunk and
extremities, ‘slapped cheeks’.
Risk to Foetus
Risk of transmission increases significantly with
increased gestation.
<20 weeks- 9% increase risk of miscarriage
3% affected foetuses- Hydrops- 50% will die
Management
Check for antibodies B19
IgG- reassure
None- send further sample in 1 month or if
rash develops
IgM- confirm- Refer for specialist care
No known Rx to prevent transmission
2 Weekly USS for hydrops
Rare- MMR
 Coryzal, lymphadenopathy, conjunctivitis,
maculopapular rash, Koplick spots


No evidence to support an association between
measles in pregnancy and congenital defects.

But- Inc- maternal mortality, foetal loss and
prematurity.
Management- identify susceptible exposed womenspecialist care- human normal immunoglobulin
 Enterovirus
 Febrile
illness o young children
 If contracted if 1st trimester- intrauterine
growth retardation and spontaneous abortion
 Refer for specialist care
 Others-
EBV, CMV
 Itchy
 In
stretch marks in later stages
 Allergic response
 Rx-
emollients and topical steroids
 Rare
 Autoimmune
 Second
and third trimester
 Itchy, blistering, initially around the
umbilicus and then the rest of the body
 Specialist
advice- skin biopsy
 Rx- topical or oral steroids
 Common
consultation
 If infectious exposure always check
antibodies and seek specialist advice if no
clear history.