Presentation on theme: "Kate Hooks. A Common Consultation AIMS: To distinguish rashes which may have complications from those which do not. To develop a management strategy."— Presentation transcript:
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, Rash- papules/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 women- specialist care- human normal immunoglobulin