1. Kate Hooks

2.  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.

3.  Detailed hx/bloods at booking  All women advised to contact GP or Midwife urgently if they are in contact with or develop a rash.

5.  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

6. 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

7. 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

8. 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.

10.  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

11.  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

12. 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

14.  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’.

15. 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

16. 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

18.  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

20.  Enterovirus  Febrile illness o young children  If contracted if 1 st trimester- intrauterine growth retardation and spontaneous abortion  Refer for specialist care  Others- EBV, CMV

22.  Itchy  In stretch marks in later stages  Allergic response  Rx- emollients and topical steroids

24.  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

25.  Common consultation  If infectious exposure always check antibodies and seek specialist advice if no clear history.